Electroconvulsive therapy is equally effective in unipolar and bipolar depression.
OBJECTIVE
To determine the relative efficacy of electroconvulsive therapy (ECT) in the treatment of bipolar (BP) and unipolar (UP) depressive illness and clarify its role in BP depression.


METHODS
Patients referred for ECT with both UP and BP depressions. [classified by Structured Clinical Interview for DSM (SCID-I) criteria for history of mania] were included in a multi-site collaborative, double-masked, randomized controlled trial of three electrode placements - right unilateral, bifrontal or bitemporal - in a permutated block randomization scheme.


RESULTS
Of 220 patients, 170 patients (77.3%) were classified as UP and 50 (22.7%) as BP depression in the intent-to-treat sample. The remission and response rates and numbers of ECT for both groups were equivalent.


CONCLUSIONS
Both UP and BP depressions remit with ECT. Polarity is not a factor in the response rate. In this sample ECT did not precipitate mania in depressed patients. Treatment algorithms for UP and BP depression warrant re-evaluation.
Bailine
S
S
Department of Psychiatry, The Zucker-Hillside Hospital Northshore-LIJ Health System, Glen Oaks, NY, USA. shbailine@aol.com
Fink
M
M
Knapp
R
R
Petrides
G
G
Husain
M M
MM
Rasmussen
K
K
Sampson
S
S
Mueller
M
M
McClintock
S M
SM
Tobias
K G
KG
Kellner
C H
CH
D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D003627:Data Interpretation, Statistical; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004565:Electroconvulsive Therapy / Q000009:adverse effects* / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts; D011569:Psychiatric Status Rating Scales; D012074:Remission Induction; D012720:Severity of Illness Index; D016896:Treatment Outcome