There is mixed evidence as to the merits of continuing versus discontinuing medication with anticonvulsants before starting electroconvulsive therapy (ECT) in patients with manic episodes. The aim of the present study was therefore to compare, in a controlled double-blind randomized clinical trial, treatment improvements and treatment outcome in patients with current manic episodes while treated with ECT with and without concurrent sodium valproate therapy.
A total of 42 inpatients (mean [SD] age, 32.1 [9.6]; 88% men) with bipolar disorders and currently during a manic state took part in the study. They were randomly assigned either to the target group (continuation of sodium valproate administration; minimum, 750 mg/d) or to the control group (discontinuation of sodium valproate administration). All patients underwent bifrontal ECT for at least 6 sessions. Improvements were rated with the Young Mania Rating Scale and the Clinical Global Impression (CGI; CGI-Severity of Illness, and CGI-Improvement).
Manic episodes as assessed by the Young Mania Rating Scale and CGI improved significantly over time and irrespective of group (target vs control group).
The pattern of results from this double-blind randomized clinical trial suggests that continuing administration of the anticonvulsant sodium valproate does neither adversely affect nor enhance the efficacy of ECT inpatients with manic episodes.