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Efficacy and Safety of Electroconvulsive Therapy in the Treatment of Bipolar Disorder: A Systematic Review

Versiani, Marcio MD, DSc*; Cheniaux, Elie MD, DSc†; Landeira-Fernandez, J. PhD‡

doi: 10.1097/YCT.0b013e3181e6332e

Objectives: To evaluate the efficacy and safety of electroconvulsive therapy (ECT) in bipolar disorder (BPD).

Methods: Clinical trials on the treatment of BPD with ECT were systematically reviewed. A comprehensive search of MEDLINE, PsycINFO, and ISI Web of Science databases was conducted in March 2010.

Results: A total of 51 articles met our selection criteria. Only 3 controlled or comparative prospective trials addressed the treatment of mania with ECT. In these studies, which had small samples, ECT was superior to simulated ECT, lithium, or the combination of lithium and haloperidol. We did not find any controlled or comparative prospective trial on the efficacy of ECT in bipolar depression. In the 4 retrospective studies that compared ECT with antidepressants, no difference was observed between them. In 9 of 10 trials that compared bipolar with unipolar depressed patients, ECT was equally efficacious for both groups of patients. Of the 6 studies of patients with BPD that performed a comparison between pre-ECT versus post-ECT, only 1 study showed a worsening in cognition after the treatment.

Conclusions: There are no studies with adequate methodology on the treatment of BPD with ECT. The lack of scientific evidence contrasts with broad anecdotal clinical experience that suggests that ECT is an important tool in the treatment of BPD, especially in more severe or refractory cases. The marked stigma associated with ECT and the lack of large financial support may account for the paucity of ECT research.

From the *Institute of Psychiatry, Federal University of Rio de Janeiro (IPUB/UFRJ); †Institute of Psychiatry, Federal University of Rio de Janeiro (IPUB/UFRJ) and State University of Rio de Janeiro (UERJ); and ‡Psychology Department, PUC-Rio and Psychology Course, Estácio de Sá University, Campus Akxe, Rio de Janeiro, Brazil.

Received for publication April 1, 2010; accepted April 25, 2010.

Reprints: Elie Cheniaux, MD, DSc, R Santa Clara, 50/1213 Copacabana, Rio de Janeiro, RJ, Brazil 22041-012 (e-mail:

This research was supported by Conselho Nacional de Pesquisa grant 522720-95-1 to JLF.

© 2011 Lippincott Williams & Wilkins, Inc.