MedWire News: Patients with bipolar depression are as likely to remit with standard electroconvulsive therapy (ECT) as those with unipolar depression, say researchers.
They found that the response and remission rates for unipolar- and bipolar-depressed patients were equivalent and over 60% for both groups, within the same time frame and with approximately the same number of treatments.
“The efficacy of ECT for both unipolar- and bipolar-depressed patients justifies its consideration in all patients with major depression,” say Samuel Bailine, from The Zucker-Hillside Hospital in New York, USA, and colleagues.
For the study, 220 patients with unipolar or bipolar depression were treated with three electrode placements – right unilateral, bifrontal, or bitemporal – in a permutated block randomized scheme. Almost all of the patients had failed to respond to drug treatment.
In all, 78.8% of 170 unipolar-depressed patients and 80.0% of 50 bipolar-depressed patients responded to treatment, defined as at least a 50% reduction from baseline in Hamilton Rating Scale for Depression (HAMD) scores.
The odds of responding did not differ significantly between the two groups after accounting for baseline depression severity, electrode placements, age, psychosis status, gender, and clinical center.
There was also no significant difference in remission rates, defined as two consecutive HAMD total scores of 10 or below and a 60% reduction in total score from baseline, at 61.2% for patients with unipolar depression and 64.0% for those with bipolar depression.
The unadjusted odds of remission were a nonsignificant 1.13-times higher for the unipolar-depressed patients than the bipolar-depressed patients.
The researchers note that the role of ECT is minimized in the current treatment guidelines.
“In the treatment of depressive illness, ECT is identified as the third or fourth option depending on the presence of psychosis. For bipolar disorder, ECT is a footnote, to be considered when all else fails,” they explain in the journal Acta Psychiatrica Scandinavica.
The researchers say that, given their findings and other published evidence of the efficacy of ECT, “treatment algorithms for bipolar depression should be modified.”
The team adds that “the usual reason given for different treatment recommendations for unipolar and bipolar depression is the risk for precipitating a manic episode with antidepressants in bipolar-depressed patients.”
In their study, however, there was a very low level of risk for switching into hypomania/mania during an ECT course, with only one patient scoring in the moderate range for mania at the end of treatment.
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