Electroconvulsive therapy effective for improving symptoms of mania

Electroconvulsive therapy was associated with improvement of symptoms in those with mania, with higher response rates in those more seriously ill and without comorbid anxiety or obsessive-compulsive disorder, per a recently published study.

“Most guidelines recommend electroconvulsive therapy (ECT) as a second-line treatment for mania,” Katarzyna Popiolek, MD, of the University Health Care Research Centre at the Örebro University in Sweden, and colleagues wrote in JAMA Network Open. “However, prognostic factors associated with a good response to ECT in individuals with mania have not been extensively investigated.

Researchers sought to investigate the response to ECT in patients who experience manic episodes, and conducted a nationwide, register-based observational cohort study that included 571 patients (37% male; median age 46 years) diagnosed with mania whose information was taken from psychiatric department records reported to the Swedish National Quality Registry for ECT between 2012 and 2019.

The main outcome of response to ECT was assessed through scores of either 1 (very much improved) or 2 (much improved) on the Clinical Global Impression Improvement scale (CGI-I), while remission was defined via the Clinical Global Impression Severity scale (CGI-S) by scores of 1 (reference range or not ill) or 2 (minimally ill) within 1 week following treatment with ECT. Univariate and multivariable regression models were used to investigate associations of sociodemographic factors, psychopharmacology and comorbidities with response.

Results showed that 482 patients (84.4%) responded to ECT, while from 514 patients diagnosed with mania, 439 (85.4%) responded to ECT. Researchers also found that comorbid anxiety (adjusted odds ratio = 0.48; 95% CI, 0.25-0.9) and OCD were associated with lower odds of response to ECT (aOR, 0.17; 95% CI, 0.06-0.56), respectively. Additionally, patients who were markedly ill (aOR = 2.93; 95% CI, 1.23-7), severely ill (aOR = 2.6; 95% CI, 1.06-6.34) or among the most extremely ill (aOR = 7.94; 95% CI, 2.16-29.21) according to CGI-S score had higher odds of response than those with mild or moderate illness.

“This study offers evidence suggesting the association of ECT with high levels of improvement in the treatment of mania in a clinical setting,” Popiolek and colleagues wrote.