In addition to its established effectiveness for treating unipolar (UP) depression, electroconvulsive therapy (ECT) is a viable treatment for bipolar (BP) I and II depression resistant to pharmacologic treatment, suggest study results.

“Several studies on responsiveness to ECT compared UP and BP depression, but differences among UP, BP II, and BP I depressive subtypes have not been discussed before,” say Giulio Perugi (University of Pisa, Italy) and co-authors.

They add: “The distinction between BP I and II has shown relevant clinical and prognostic impact that might influence response to ECT.”

To investigate, Perugi and team administered twice-weekly bilateral ECT to patients with UP depression (n=17), BP II (n=67), and BP I (n=46) disorder who were currently depressed and showed resistance to pharmacologic treatment. The total number of lifetime episodes was greater in patients with BP I than UP and BP II (6.7 vs 5.5 and 5.2, respectively), while current episode length was similar in all three diagnostic subtypes.

Patients were assessed at baseline and a week after the ECT course using a set of standardized measures. The mean number of ECT sessions was 7.2 per patient.

All patients showed a significant improvement after the ECT course, with global response rates (defined as a final Clinical Global Improvement [CGI] severity score of less than 2) of 94.1%, 79.1%, and 67.4% for UP, BP II, and BP I, respectively. Similar results were obtained when response rate was defined as a 50% reduction on the Hamilton Rating Scale for Depression (HAM-D), with corresponding values of 88.2%, 73.1%, and 69.6%.

However, the rate of remission ??” defined as a final CGI severity score of 1 ??” was nearly twice as high in UP (70.6%) than in BP I (41.3%). No significant differences were seen between UP and BP II and between BP II and BP I.

Defining remission according to a final HAM-D score of less than 8 showed that remission rates were higher in the UP group (70.6%) than in BP II (43.3%) and in BP I (34.8%).

At the final evaluation BP I patients showed a less complete response, with residual manic and psychotic symptomatology after ECT compared with BP II and UP patients.

“It is possible that this residual symptomatology may account for a worse outcome, utilizing subjective measures,” write the authors in the Journal of Affective Disorders.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

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