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The Role of Electroconvulsive Therapy (ECT) in Bipolar Disorder: Effectiveness in 522 Patients with Bipolar Depression, Mixed-state, Mania and Catatonic Features.
Curr Neuropharmacol. 2017 04; 15(3):359-371.CN

Abstract

OBJECTIVE

We evaluated the effectiveness of Electroconvulsive Therapy (ECT) in the treatment of Bipolar Disorder (BD) in a large sample of bipolar patients with drug resistant depression, mania, mixed state and catatonic features.

METHOD

522 consecutive patients with DSM-IV-TR BD were evaluated prior to and after the ECT course. Responders and nonresponders were compared in subsamples of depressed and mixed patients. Descriptive analyses were reported for patients with mania and with catatonic features.

RESULTS

Of the original sample only 22 patients were excluded for the occurrence of side effects or consent withdrawal. After the ECT course, 344 (68.8%) patients were considered responders (final CGIi score ≤2) and 156 (31.2%) nonresponders. Response rates were respectively 68.1% for BD depression, 72.9% for mixed state, 75% for mania and 80.8% for catatonic features. Length of current episode and global severity of the illness were the only statistically significant predictors of nonresponse.

CONCLUSION

ECT resulted to be an effective and safe treatment for all the phases of severe and drug-resistant BD. Positive response was observed in approximately two-thirds of the cases and in 80% of the catatonic patients. The duration of the current episode was the major predictor of nonresponse. The risk of ECT-induced mania is virtually absent and mood destabilization very unlikely. Our results clearly indicate that current algorithms for the treatment of depressive, mixed, manic and catatonic states should be modified and, at least for the most severe patients, ECT should not be considered as a "last resort".

Authors+Show Affiliations

Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. Institute of Behavioral Science "G. De Lisio", Carrara-Pisa, Pisa, Italy.Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.Institute of Behavioral Science "G. De Lisio", Carrara-Pisa, Pisa, Italy.Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

28503107

Citation

Perugi, Giulio, et al. "The Role of Electroconvulsive Therapy (ECT) in Bipolar Disorder: Effectiveness in 522 Patients With Bipolar Depression, Mixed-state, Mania and Catatonic Features." Current Neuropharmacology, vol. 15, no. 3, 2017, pp. 359-371.
Perugi G, Medda P, Toni C, et al. The Role of Electroconvulsive Therapy (ECT) in Bipolar Disorder: Effectiveness in 522 Patients with Bipolar Depression, Mixed-state, Mania and Catatonic Features. Curr Neuropharmacol. 2017;15(3):359-371.
Perugi, G., Medda, P., Toni, C., Mariani, M. G., Socci, C., & Mauri, M. (2017). The Role of Electroconvulsive Therapy (ECT) in Bipolar Disorder: Effectiveness in 522 Patients with Bipolar Depression, Mixed-state, Mania and Catatonic Features. Current Neuropharmacology, 15(3), 359-371. https://doi.org/10.2174/1570159X14666161017233642
Perugi G, et al. The Role of Electroconvulsive Therapy (ECT) in Bipolar Disorder: Effectiveness in 522 Patients With Bipolar Depression, Mixed-state, Mania and Catatonic Features. Curr Neuropharmacol. 2017;15(3):359-371. PubMed PMID: 28503107.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Role of Electroconvulsive Therapy (ECT) in Bipolar Disorder: Effectiveness in 522 Patients with Bipolar Depression, Mixed-state, Mania and Catatonic Features. AU - Perugi,Giulio, AU - Medda,Pierpaolo, AU - Toni,Cristina, AU - Mariani,Michela Giorgi, AU - Socci,Chiara, AU - Mauri,Mauro, PY - 2017/5/16/entrez PY - 2017/5/16/pubmed PY - 2018/3/6/medline KW - Bipolar Disorder KW - Bipolar depression KW - Electroconvulsive Therapy (ECT) KW - Mania KW - Mixed State KW - Mood stabilizer KW - catatonia SP - 359 EP - 371 JF - Current neuropharmacology JO - Curr Neuropharmacol VL - 15 IS - 3 N2 - OBJECTIVE: We evaluated the effectiveness of Electroconvulsive Therapy (ECT) in the treatment of Bipolar Disorder (BD) in a large sample of bipolar patients with drug resistant depression, mania, mixed state and catatonic features. METHOD: 522 consecutive patients with DSM-IV-TR BD were evaluated prior to and after the ECT course. Responders and nonresponders were compared in subsamples of depressed and mixed patients. Descriptive analyses were reported for patients with mania and with catatonic features. RESULTS: Of the original sample only 22 patients were excluded for the occurrence of side effects or consent withdrawal. After the ECT course, 344 (68.8%) patients were considered responders (final CGIi score ≤2) and 156 (31.2%) nonresponders. Response rates were respectively 68.1% for BD depression, 72.9% for mixed state, 75% for mania and 80.8% for catatonic features. Length of current episode and global severity of the illness were the only statistically significant predictors of nonresponse. CONCLUSION: ECT resulted to be an effective and safe treatment for all the phases of severe and drug-resistant BD. Positive response was observed in approximately two-thirds of the cases and in 80% of the catatonic patients. The duration of the current episode was the major predictor of nonresponse. The risk of ECT-induced mania is virtually absent and mood destabilization very unlikely. Our results clearly indicate that current algorithms for the treatment of depressive, mixed, manic and catatonic states should be modified and, at least for the most severe patients, ECT should not be considered as a "last resort". SN - 1875-6190 UR - https://www.unboundmedicine.com/medline/citation/28503107/The_Role_of_Electroconvulsive_Therapy__ECT__in_Bipolar_Disorder:_Effectiveness_in_522_Patients_with_Bipolar_Depression_Mixed_state_Mania_and_Catatonic_Features_ L2 - https://www.ingentaconnect.com/openurl?genre=article&issn=1570-159X&volume=15&issue=3&spage=359&aulast=Perugi DB - PRIME DP - Unbound Medicine ER -