ELECTROCONVULSIVE-THERAPY OF ACUTE MANIC EPISODES - A REVIEW OF 50 YEARS EXPERIENCE

Objective: The most common indication for electroconvulsive therapy (E CT) is major depression. It is less recognized that ECT is effective a lso in the treatment of acute mania. This article aims to Provide a co mprehensive and critical review of the literature on the use of ECT fo r manic patients. Method: All published papers in the English language on the use of ECT in acute mania that could be found were reviewed wi th regard to efficacy, frequency and number of treatments, bilateral v ersus unilateral electrode placement, predictors of antimanic response , stability of therapeutic response, cognitive consequences, and other relevant issues. Results: The evidence indicates that ECT is associat ed with remission or marked clinical improvement in 80% of manic patie nts and that it is an effective treatment for patients whose manic epi sodes 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 th an in depressed patients. The issues of relapse following response to ECT, cognitive consequences of ECT, and the relative merits of unilate ral versus bilateral ECT in manic patients require further study. Conc lusions: ECT is an effective and safe treatment for acute mania. Remis sion of mania following ECT reflects a primary therapeutic effect rath er than a secondary consequence of an ECT-induced organic brain syndro me.