title: What happens to the course of bipolar disorder after electroconvulsive therapy?
abstract: BACKGROUND
  Bipolar disorder (BD) encompasses manic and depressive episodes and an illness-free interval. Treatments used in BD patients may influence the ill phases with different actions on the illness-free interval.
  
  
  METHODS
  We performed a naturalistic mirror-image retrospective study analyzing the number of episodes and admissions in 41 BD patients for the same period of time of 5 years before and after electroconvulsive therapy (ECT). Furthermore, we assessed the duration of free intervals before and after ECT as a sign of prolonged well-being. Univariate analysis with t-test was used to compare differences before and after ECT, while analysis of variance was used to compare factors possibly associated with the efficacy on free-interval of ECT.
  
  
  RESULTS
  Comparing the 5-year periods before and after ECT, we found significantly longer [13.2 ± 9.0 months before ECT to 25.1 ± 19.1 after treatment (t=3.8; p<0.0001)] free intervals, as well as significant reductions in the number of episodes [5.9 ± 3.0 before ECT to 1.0 ± 1.7 after treatment (t=9.3; p<0.0001)], and in the number of admissions [2.2 ± 1.3 before ECT to 0.2 ± 0.5 after treatment (t=9.4; p<0.0001)].
  
  
  CONCLUSIONS
  The main limitations of this study consisted in the relatively small sample size, the mirror-image retrospective naturalistic study design and possibly patient selection bias.
  
  
  CONCLUSIONS
  Electroconvulsive therapy seemed to increase free-intervals and reduced number of BD episodes and admissions. It is plausible that ECT, along with suspending antidepressant treatment, might carry intrinsic stabilizing effect on the course of BD.
authors.affiliation: Psychiatry Unit, San Martino Hospital - Health Agency N. 5, Oristano, Sardinia, Italy.
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Minnai
authors.affiliation: Psychiatry Unit, San Martino Hospital - Health Agency N. 5, Oristano, Sardinia, Italy.
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Salis
authors.affiliation: Section of Psychiatry, Department of Public Health, Molecular and Clinical Medicine, University of Cagliari, Sardinia, Italy; Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Mirko
authors.initials: M
authors.lastname: Manchia
authors.affiliation: Psychiatry Unit, San Martino Hospital - Health Agency N. 5, Oristano, Sardinia, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Pinna
authors.affiliation: Lucio Bini Mood Disorder Center, Rome, Italy; Lucio Bini Mood Disorder Centers, Cagliari, Italy; Department of Psychiatry, Harvard Medical School, Boston, MA, USA. Electronic address: ltondo@aol.com.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Tondo
mesh_terms: D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000523:psychology* / Q000628:therapy*; D004565:Electroconvulsive Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Antidepressants; Bipolar disorder; Clinical course; ECT; Free interval; Mood stabilizers