The Mood-Stabilizing Effects of Electroconvulsive Therapy

Abstract

The "ideal" mood stabilizer has been defined as an agent displaying demonstrated efficacy for the acute treatment and long-term prevention of both mania and depression. On the basis of a selective and an extensive review of the existing literature primarily focused on prospective and controlled studies, we discuss the potential mood-stabilizing effects of electroconvulsive therapy (ECT) and its efficacy for the acute treatment of bipolar depressive and mixed-manic states and the prevention of all types of recurrences of bipolar disorder (BD). We conclude that ECT should be considered an effective acute treatment for the depressive and manic-mixed states of BD, as ECT displays response and remission rates superior to those of other treatment approaches, even in severe and treatment-resistant cases. From this point of view, its clinical mood-stabilizing effects are clearly superior compared with other pharmacological approaches because most treatments that alleviate bipolar depression can cause mania, hypomania, mood instability, or rapid cycling and treatments that can control mania can induce or precipitate depressive symptoms or episodes. The ECT-induced mania is rare, and there are no data suggesting possible long-term mood destabilization, including cycle induction or acceleration. Conversely, several case reports and open trials reported a significant reduction in morbidity among patients experiencing rapid-cycling BD. Regarding relapse prevention, c-ECT and m-ECT are considered as appropriate therapies for treatment-resistant patients exhibiting high rates of depressive or mixed relapse. Further investigation is necessary to identify the frequency and duration of continued treatment after a successful index course of ECT.

Rapid and stable changes in maturation-related phenotypes of the adult hippocampal neurons by electroconvulsive treatment

“…In addition, α-CaMKII hetero KO mice show profound immaturity of the DG and infradian oscillation of home-cage activity levels [2]. Thus, the invariable effect of ECS may be related to a relatively low risk for switching to mania in patients with bipolar disorder who are treated with ECT [30]. While ECT rapidly alleviates acute episodes of depression, relapse rates are relatively high after discontinuation of the therapy [31, 32].…”

Mania secondary to focal brain lesions: implications for understanding the functional neuroanatomy of bipolar disorder

“…Combination treatment with a mood stabilizer and an SGA is more effective than monotherapy, and is preferred for severe mania . ECT is effective for severe or treatment‐refractory mania, but neurological/neurosurgical consultation should first be sought to ensure it is safe in the presence of brain disease . In practice, there are few absolute contra‐indications to ECT.…”

Speed of antidepressant response to electroconvulsive therapy in bipolar disorder vs. major depressive disorder

“…Recent literature has supported the efficacy of electroconvulsive therapy (ECT) in bipolar disorder (Medda et al, 2014) including BPD (Grunhaus et al, 2002; Bailine et al, 2010; Dierckx et al, 2012; Schoeyen et al, 2015), and ECT may have a role in maintaining wellness (Vaidya et al, 2003). Modern ECT is adequately tolerated (Versiani et al, 2011); the rate of conversion to mania is low (Bailine et al, 2010), and cognitive side effects are minimized when current recommendations regarding technique and monitoring are followed (Sackeim and Prudic, 2005; Kellner et al, 2016).…”