Am J Psychiatry 1994; 151:169-176
Copyright © 1994 by American Psychiatric Association
Electroconvulsive therapy of acute manic episodes: a review of 50 years' experience
S Mukherjee, HA Sackeim and DB Schnur
Department of Psychiatry, Medical College of Georgia, Augusta 30912- 3800.
OBJECTIVE: The most common indication for electroconvulsive therapy (ECT)
is major depression. It is less recognized that ECT is effective also in
the treatment of acute mania. This article aims to provide a comprehensive
and critical review of the literature on the use of ECT for manic patients.
METHOD: All published papers in the English language on the use of ECT in
acute mania that could be found were reviewed with regard to efficacy,
frequency and number of treatments, bilateral versus unilateral electrode
placement, predictors of antimanic response, stability of therapeutic
response, cognitive consequences, and other relevant issues. RESULTS: The
evidence indicates that ECT is associated with remission or marked clinical
improvement in 80% of manic patients and that it is an effective treatment
for patients whose manic episodes have responded poorly to pharmacotherapy.
Manic patients do not require a high frequency or prolonged course of
treatments to respond to ECT. The seizure threshold appears to be lower in
manic patients than in depressed patients. The issues of relapse following
response to ECT, cognitive consequences of ECT, and the relative merits of
unilateral versus bilateral ECT in manic patients require further study.
CONCLUSIONS: ECT is an effective and safe treatment for acute mania.
Remission of mania following ECT reflects a primary therapeutic effect
rather than a secondary consequence of an ECT-induced organic brain
syndrome.
