Electroconvulsive Therapy- Manic Episodes

Electroconvulsive Therapy: Manic Episodes

Evidence for Acute-Phase Efficacy
ECT is highly effective in its ability to induce a remission in manic states, with 80% of patients showing marked improvement (Mukherjee et al. 1994). The relative efficacy of ECT versus a lithium/antipsychotic combination was more recently the subject of two controlled investigations. The first study (Small et al. 1988), which allowed the use of antipsychotics with ECT, found that ECT plus antipsychotic was at least as effective as lithium plus antipsychotic, with various trends in the data favoring ECT. The second trial (Mukherjee 1994), carried out in patients whose depression was initially nonresponsive to either lithium or an antipsychotic, showed a 59% incidence of marked response to ECT alone compared with a 0% incidence of response to lithium plus the antipsychotic. These studies provide additional evidence that ECT is demonstrably effective in mania but raise as-yet-unanswered questions concerning whether antipsychotic agents might potentiate the antimanic response to ECT and whether the response is diminished in patients who are medication-resistant during their current episode.

Despite its efficacy in mania, ECT is currently used primarily for patients who are resistant or intolerant to alternative treatments or in cases when there is an urgent need for a rapid response (American Psychiatric Association 1994b). This pattern of use probably represents a relative underutilization of this treatment modality. A case discussion describing the use of ECT in the treatment of mania is provided at the end of this chapter.

Electroconvulsive Therapy Introduction Indications