Electroconvulsive therapy in the treatment of severe mania. Case report and state of knowledge

Despite newly developed pharmacological possibilities, treatment of acute m ania may still be a problem in single patients. Independent of the first ch oice of medication, i.e. neuroleptics, lithium, carbamazepine or valproate, the average response rate is only approximately 50-70%. Therefore, treatin g mania often implies a number of monotherapeutic and polypharmaceutic atte mpts for several months, until a sufficient mood stabilization has been rea ched. The aim of this case report is to remind that electroconvulsive therapy (EC T) is still in use for treating mania, which has been widely neglected in G ermany despite its high success rate, mainly reported from Anglo-Saxon coun tries. As demonstrated in this report, ECT may be a useful tool for a fast antimanic response in patients which may be either refractory to standard t reatment or are medically severely ill,and should, in our opinion, therefor e be considered already at an earlier stage of treatment in this group. How ever, persistence of improvement can usually only be achieved with the over lapping start of drug treatment unless the option of maintenance ECT is giv en.