title: Treatment-resistant bipolar depression: a randomized controlled trial of electroconvulsive therapy versus algorithm-based pharmacological treatment.
abstract: OBJECTIVE
  Electroconvulsive therapy (ECT) is regarded by many clinicians as the most effective treatment for treatment-resistant bipolar depression, but no randomized controlled trials have been conducted, to the authors' knowledge. They compared efficacy measures of ECT and algorithm-based pharmacological treatment in treatment-resistant bipolar depression.
  
  
  METHODS
  This multicenter, randomized controlled trial was carried out at seven acute-care psychiatric inpatient clinics throughout Norway and included 73 bipolar disorder patients with treatment-resistant depression. The patients were randomly assigned to receive either ECT or algorithm-based pharmacological treatment. ECT included three sessions per week for up to 6 weeks, right unilateral placement of stimulus electrodes, and brief pulse stimulation.
  
  
  RESULTS
  Linear mixed-effects modeling analysis revealed that ECT was significantly more effective than algorithm-based pharmacological treatment. The mean scores at the end of the 6-week treatment period were lower for the ECT group than for the pharmacological treatment group: by 6.6 points on the Montgomery-Åsberg Depression Rating Scale (SE=2.05, 95% CI=2.5-10.6), by 9.4 points on the 30-item version of the Inventory of Depressive Symptomatology-Clinician-Rated (SE=2.49, 95% CI=4.6-14.3), and by 0.7 points on the Clinical Global Impression for Bipolar Disorder (SE=0.31, 95% CI=0.13-1.36). The response rate was significantly higher in the ECT group than in the group that received algorithm-based pharmacological treatment (73.9% versus 35.0%), but the remission rate did not differ between the groups (34.8% versus 30.0%).
  
  
  CONCLUSIONS
  Remission rates remained modest regardless of treatment choice for this challenging clinical condition.
authors.affiliation: From the Division of Psychiatry and the Research Department, Stavanger University Hospital, Stavanger, Norway; the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; the Institute of Clinical Medicine and Neuropsychiatry, the Department of Emergency Mental Health Services, and the Gerontopsychiatric Unit, Oslo University Hospital, Ullevaal, Norway; the Østmarka Department of Psychiatry, St. Olav University Hospital of Trondheim, Trondheim, Norway; the Psychiatry Clinic, Oslo University Hospital, Aker, Norway; and the Psychiatry Clinic, Østfold County Hospital, Fredrikstad, Norway.
authors.forename: Helle K
authors.initials: HK
authors.lastname: Schoeyen
authors.forename: Ute
authors.initials: U
authors.lastname: Kessler
authors.forename: Ole A
authors.initials: OA
authors.lastname: Andreassen
authors.forename: Bjoern H
authors.initials: BH
authors.lastname: Auestad
authors.forename: Per
authors.initials: P
authors.lastname: Bergsholm
authors.forename: Ulrik F
authors.initials: UF
authors.lastname: Malt
authors.forename: Gunnar
authors.initials: G
authors.lastname: Morken
authors.forename: Ketil J
authors.initials: KJ
authors.lastname: Oedegaard
authors.forename: Arne
authors.initials: A
authors.lastname: Vaaler
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy / Q000628:therapy*; D061218:Depressive Disorder, Treatment-Resistant / Q000188:drug therapy / Q000628:therapy*; D004565:Electroconvulsive Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D011569:Psychiatric Status Rating Scales; D012074:Remission Induction / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents