Electroconvulsive Therapy in Medication-Nonresponsive Patients With Mixed Mania and Bipolar Depression
J Clin Psychiatry 2001;62(7):552-555
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: The aim of this study was to
investigate the effectiveness of electroconvulsive therapy (ECT)
in medication-nonresponsive patients with mixed mania and bipolar
Method: Forty-one patients with mixed mania
(DSM-IV diagnosis of bipolar I disorder, most recent episode
mixed) and 23 patients with bipolar depression (DSM-IV diagnosis
of bipolar I disorder, most recent episode depressed)
consecutively assigned to ECT treatment were included in this
study. Subjects were evaluated using the Montgomery-Asberg
Depression Rating Scale (MADRS), the Brief Psychiatric Rating
Scale (BPRS), and the Clinical Global Impressions-Severity of
Illness scale (CGI-S). Assessments were carried out the day
before starting ECT, 48 hours after completion of the third
session (T1), and a week after the last session of ECT
Results: Both groups received an equal number of
ECT sessions (mean ± SD = 7.2 ± 1.7 vs. 7.3 ± 1.6). In both
groups, within-group comparisons showed that there was a
significant reduction in CGI-S score (mixed mania, p < .0001
at T1 and T2; bipolar depression, p <
.01 at T1, p < .0001 at T2), MADRS total
score (both groups, p < .0001 at T1 and T2),
BPRS total score (mixed mania, p < .0001 at T1 and
T2; bipolar depression, p < .001 at T1,
p < .0001 at T2), and BPRS activation factor score
(mixed mania, p < .0001 at T1 and T2;
bipolar depression, NS at T1, p < .01 at T2).
Between-group comparisons revealed that patients with mixed mania
showed significantly greater decrease in MADRS score (p <
.001) and a greater proportion of responders (CGI-S) than
patients with bipolar depression at endpoint (56% [N = 23] vs.
26% [N = 6], p = .02). Patients with mixed mania showed a greater
reduction in suicidality, as measured by MADRS score, than
patients with bipolar depression (p < .02).
Conclusion: In our study, ECT was associated
with a substantial reduction in symptomatology, in both patients
with mixed mania and those with bipolar depression. However, the
mixed mania group exhibited a more rapid and marked response as
well as a greater reduction in suicidal ideation. Response to ECT
was not influenced by the presence of delusions.