title: Occurence of ultra-rapid cycling during electroconvulsive therapy in bipolar depression.
abstract: BACKGROUND
  Treatment of bipolar depression with antidepressants has often been reported to be associated with a certain risk of rapid cycling (RC). Also, non-pharmacological treatment approaches such as sleep deprivation or light therapy can induce affective shifts. Moreover, during electroconvulsive therapy (ECT), which is considered a powerful antidepressant treatment, manic switches and episodes of rapid cycling can occur.
  
  
  METHODS
  Here we report the case of a 66-year-old female patient with bipolar depression, who underwent electroconvulsive therapy because of a therapy-refractory depressive episode.
  
  
  RESULTS
  During ECT, highly frequent mood alternations were observed, fulfilling the criteria of ultra rapid cycling (URC). These symptoms were successfully treated with lithium carbonate while ECT was continued.
  
  
  CONCLUSIONS
  To our knowledge, this is the first case report of URC during ECT. URC might be considered a rare but potential side effect of ECT. In our case, lithium was used successfully for the treatment of URC and might be suggested in similar cases, where anticonvulsants are not the first choice of treatment. However, in view of the risk of cognitive side effects the combination of ECT and lithium requires a careful clinical monitoring.
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany. maxim.zavorotnyy@ukmuenster.de
authors.forename: Maxim
authors.initials: M
authors.lastname: Zavorotnyy
authors.forename: Julia
authors.initials: J
authors.lastname: Diemer
authors.forename: Julia
authors.initials: J
authors.lastname: Patzelt
authors.forename: Andreas
authors.initials: A
authors.lastname: Behnken
authors.forename: Peter
authors.initials: P
authors.lastname: Zwanzger
mesh_terms: D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000628:therapy*; D003865:Major Depressive Disorder / Q000188:drug therapy; D016903:Drug Monitoring; D004565:Electroconvulsive Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D016651:Lithium Carbonate / Q000627:therapeutic use; D012008:Recurrence
chemical_list: D014150:Antipsychotic Agents; D016651:Lithium Carbonate