Electroconvulsive therapy (ECT) in bipolar disorder: A narrative review of literature

In many countries including India electroconvulsive therapy (ECT) is frequently used to treat different phases of bipolar disorder. The response to ECT is impressive in mania, depression and in mixed affective states. Preliminary evidence also suggests benefit from maintenance ECT in bipolar disorder. However, most of the literature on efficacy and adverse effects comes from case series, retrospective reports and open trials – controlled trials have been few and far between. Official guidelines recommend the use of ECT only when there is a dire emergency or when all other options have been exhausted. Concurrent use of lithium and antiepileptic drugs along with ECT is common in clinical practice. While such practice appears to be largely safe, one should be mindful about dose of lithium and possible interference of antiepileptic drugs with efficacy of ECT. The use of suprathreshold bilateral ECT and bifrontal placement of electrodes may confer some advantage over other methods.

► ECT is often used to treat different phases of bipolar disorder in many countries.
► Bilateral ECT is as effective as pharmacotherapy in treatment of acute mania.
► Quality evidence is lacking regarding the use of ECT in refractory bipolar disorder.
► Merits and demerits of combining ECT and mood stabilizers need to be established.