Abstract
The treatment of a depressive episode of bipolar disorder (BD) represents an arduous clinical situation with a limited number of confirmed treatment interventions and frequent pharmacoresistance. Electroconvulsive therapy (ECT) is a proven method of choice in severe or to other treament resistant episodes of major depressive disorder (MDD), with much less information on the efficacy and safety of the method in the BD.
However, studies to date show comparable efficacy with a total remission rate of about 50 % and a response rate of about 75 %. The findings also suggest the possibility of a shorter response time and higher efficacy in type II bipolar disorder.
The occurrence of hypomanic or manic switches or other forms of disease destabilisation is low and the impact of ECT on the further course of the illness seems rather favourable. The question of ECT application when using lithium remains controversial.
Although there is information on both complications and safe use with potential benefits of concurrent intervention, a recent population study clearly shows a higher incidence of delirium and other cognitive disorders when administered concomitantly. Increased caution and dose adjustment or the discontinuation of lithium use for a period of ECT thus appear to be an appropriate strategy in this clinical situation.
In contrast, use of anticonvulsans is not associated with the the higher risk, and, with the exception of older drugs (valproate and carbamazepine), no adjustment of ECT parameters or drug dose is likely to be necessary. Continuation and maintenance ECT may represent a successful intervention in the patient with unsatisfactory pharmacological prophylaxis or an unstable disease course, but information is still limited.
Despite certain specifics of bipolar depression, electroconvulsive therapy in the indication of a depressive episode can be considered an effective and relatively safe method.