Electroconvulsive Therapy in Mania: A Review of 80 Years of Clinical Experience

Resistance to pharmacological agents is commonly encountered in the treatment of acute episodes of mania. In contemporary practice guidelines, electroconvulsive therapy (ECT), once a widely used standalone intervention for mania, is no longer considered a first-tine treatment. Stigma, logistics, and ethical factors constrain ECT administration in this condition and lead to its underutitization. However, the past three decades have produced promising research regarding the use of ECT in mania. Randomized controlled trials, albeit in limited numbers, the adoption of ultrabrief ECT, examination of the safety and efficacy of combining ECT with pharmacological agents, including lithium, and use of ECT as a maintenance strategy have enhanced our understanding of how and when to utilize this intervention in mania. In this comprehensive review, the authors summarize the evidence regarding the efficacy and safety of ECT in mania, including related syndromes, such as delirious mania and mixed affective states. The impact of technical parameters, particularly the choice of treatment frequency, electrode placements, and pulse width, are discussed in the tight of recent evidence.

Automated summary

While electroconvulsive therapy (ECT) is no longer the first-line treatment for mania, recent research has shown promising results in its use, including the adoption of ultrabrief ECT, combination with pharmacological agents, and use as a maintenance strategy. Technical parameters, such as treatment frequency, electrode placements, and pulse width, play a critical role in its efficacy.