Comparative Response to Electroconvulsive Therapy in Medication-Resistant Bipolar I Patients With Depression and Mixed State

Objectives: We compared the response with electroconvulsive therapy (ECT) of bipolar I patients resistant to pharmacological treatment, who presented depression or mixed state (MS). Methods: Ninety-six bipolar I patients according to the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition were included in the study (46 with major depressive episode and 50 with MS). Bilateral ECT was delivered using a brief pulse stimulator Mecta 5000Q (Mecta Corp, Lake Oswego, Ore) on a twice-a-week schedule. The patients were evaluated before ECT (baseline) and a week after the ECT course (final score), using the Hamilton Rating Scale for Depression (HAM-D), Mania Rating Scale, Brief Psychiatric Rating Scale (BPRS), and Clinical Global Improvement (CGI). Results: Global response rate (CGI <= 2) was similar in bipolar depression and MS (67.4% and 76.0%, respectively); no difference was found in global remission rate (CGI <= 1) between depression (41.3%) and MS (34.8%). The response rate of depressive symptoms (HAM-D <= 50% was 69.6% for bipolar depression and 66.0% for MS; remission rate (HAM-D <= 8) was 26.1% and 30.0%, respectively. At the end of the ECT course, CGI-Severity, HAM-D total, Young Mania total, BPRS total, and psychotic cluster scores showed a progressive reduction in both groups. A significant group effect was present for Young mania total score, BPRS total score, and psychotic cluster. Limitations: With the exception of anticonvulsants, concomitant psychotropic medications were permitted during ECT course, based on the physician's decision. Conclusions: Electroconvulsive therapy should be considered a viable treatment alternative in bipolar I patients with depression or MS who do not respond to conventional pharmacologic management. The only difference is that MS may present more residual agitation or psychotic features in comparison with depressive patients.