The first line of treatment for BD is mood-stabilizing medication, such as lithium or anticonvulsants, but is ECT a valid alternative treatment, perhaps even used fairly early on in the treatment course?
Dear Neil;
There is no clear answers emerge from the literature: But there is a growing body of evidence to suggest that for those patients who have not responded well to medications but have responded to ECT, Maintenance-ECT must be presented as an option to the patient.
Rabheru K. demonstrated that relapse rates after discontinuation of ECT are very high. But M-ECT is an underused treatment option that can substantially reduce risks of relapse in patients with major depressive disorder and likely in bipolar disorder and schizophrenia as well.
Review: Rabheru K. Maintenance electroconvulsive therapy (M-ECT) after acute response: examining the evidence for who, what, when, and how?
J ECT. 2012 Mar;28(1):39-47. doi: 10.1097/YCT.0b013e3182455758.
I found the following review article on the efficacy of using ECT with Bipolar patients. The abstract is excerpted below:
Dierckx B, Heijnen WT, van den Broek WW, Birkenha¨ ger TK. Efficacy
of electroconvulsive therapy in bipolar versus unipolar major depression:
a meta-analysis. Bipolar Disord 2012: 14: 146–150.
Objective: Bipolar major depression differs considerably from unipolar
major depression with regard to the efficacy of treatment with
antidepressants. In bipolar depression, response to treatment with
antidepressants is disappointing. Whether response to electroconvulsive
therapy (ECT) differs between bipolar and unipolar depression remains
unclear. Therefore, this systematic review investigates the relative efficacy
of ECT in both forms of depression.
Methods: Relevant cohort studies were identified from a systematic
search of the PubMed electronic database. Six studies were included in
this meta-analysis.
Results: In this meta-analysis, the overall remission rate was 50.9%
(n = 402 ⁄ 790) for patients with unipolar depression and 53.2%
(n = 168 ⁄ 316) for patients with bipolar major depression. A pooled
odds ratio (OR) and confidence interval (CI) were calculated using
random-effects meta-analysis with the Mantel–Haenzel method. This
analysis shows similar efficacy of ECT in patients with unipolar and
bipolar depression (OR = 1.08, 95% CI: 0.75–1.57).
Conclusion: ECT appears to be equally effective for both bipolar and
unipolar depression and the remission rates are encouraging, especially
for bipolar depression.
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