ECT Particularly Effective in Treating Severe Mania
Most patients with mania responded to electroconvulsive therapy (ECT), according to a Swedish study published in JAMA Network Open. Patients with more severe illness were also far more likely to respond to treatment, the study’s researchers found.
The study recruited 571 individuals who were in a manic episode treated with ECT, 482 (84.4%) responded. Of these, 28% of these patients were able to achieve remission of mania, the researchers found. ECT treatments were mostly given three times a week.
The patient group was 63% female, with a median age of 46. Most had mania with psychotic symptoms, and roughly a quarter were voluntarily admitted to the hospital, while 60% were involuntarily committed. About 45% had been exposed to prior ECT.
“These findings suggest that ECT may be a highly effective option for treating mania, which is in line with the literature reporting response rates of 56% to 100%,” the authors noted.
The severity of illness was associated with an increased chance of responding to ECT; 83% for markedly ill, 84% for severely ill, and 92% for extremely ill patients. Illness severity was graded according to Clinical Global Impression Improvement scale (CGI-I) score.
Additionally, patients who underwent more ECT treatments in an index series were significantly more likely to have a clinical response, with the greatest odds of response being among patients who received more than 9 treatments.
Clinical factors reducing a patient’s odds of responding to ECT included comorbid anxiety and comorbid obsessive compulsive disorder.
Factors not associated with a clinical response to ECT were age of mania onset, as well as psychopharmacotherapy before index admission, including lithium, lamotrigine, a first or second generation antipsychotic, valproate, benzodiazepine, antidepressant, anxiolytic, or a central stimulant.
“It is worth highlighting that 63% of patients in our study were treated with 1 or more antimanic agents before admission, suggesting that these treatments may not have been sufficient in reducing symptoms of mania,” the group noted.
Source: MedPage Today
