Efficacy of electroconvulsive therapy in treatment-resistant bipolar disorder: a case series.
The response to electroconvulsive therapy for six bipolar patients after pharmacotherapy failure is discussed.


METHODS
Inclusion criteria were as follows: (1) bipolar mood disorder, manic, depressive or mixed episode (DSM-IV); (2) failure of pharmacotherapy, that is, for mania, manic episode unresponsive to at least 2 adequate antimanic trials for 6 weeks; and for bipolar depression, bipolar depressive episode unresponsive to at least 2 adequate antidepressant trials for 8 weeks. The patients underwent 12 bilateral sessions of ECT 3 times per week. Clinical response was considered a reduction of 50% or greater in the Young Mania Rating Scale (YMRS) and in the Hamilton Rating Scale for Depression-21 items (HAMD-21). Final YMRS <6 and HAMD-21 <8 defined remission.


RESULTS
Six of the 9 referred patients consented to be submitted to ECT. Four were male, with ages ranging from 29 to 61 years, and their age at onset ranged from 19 to 49 years. Four showed psychotic features. All responded to ECT.
Macedo-Soares
Marcia Britto de
MB
Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil. marciabms@uol.com.br
Moreno
Ricardo A
RA
Rigonatti
Sergio P
SP
Lafer
Beny
B
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D018692:Antimanic Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy / Q000628:therapy*; D004351:Drug Resistance; D004565:Electroconvulsive Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D017211:Treatment Failure
D000928:Antidepressive Agents; D018692:Antimanic Agents; D014150:Antipsychotic Agents