Journal of Depression and Anxiety
Open Access

Abstract

ECT in Bipolar Disorder: Incidence of Switch from Depression to Hypomania or Mania

Emily Bost- Baxter, Irving M Reti and Jennifer L Payne

Background: Electroconvulsive Therapy (ECT) is an effective treatment for bipolar depression. However, it remains unclear how often patients with bipolar disorder who are receiving ECT “switch” from a depressed to a hypomanic or manic state. Our objective was to determine the switch rate in a sample of inpatients with bipolar disorder who received ECT, and to determine which clinical variables were associated with a greater likelihood of switch.

Methods: We performed a retrospective chart review of 100 inpatients treated with ECT for a depressive episode who had a diagnosis of bipolar disorder type I or II. We determined the incidence of switch into hypomania or mania and the impact of clinical features and ECT treatment variables on switching.

Results: The incidence of switch in our sample was 24.8%. Diagnosis, concurrent antidepressant medications, lack of the use on an antimanic agent, and a history of rapid cycling were not associated with an increased risk of switch. In a subset of patients who were not taking anti-manic medications during ECT, switch was associated with receiving a higher number of ECT treatments (p=0.02).

Conclusions: A quarter of all patients with bipolar disorder switched from a depressive episode into hypomania or mania with administration of ECT. Psychiatrists should be alert to the substantial risk of mood switching when treating bipolar depression with ECT.