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Comparing Efficacy of ECT With and Without Concurrent Sodium Valproate Therapy in Manic Patients

Jahangard, Leila MD*; Haghighi, Mohammad MD*; Bigdelou, Gholamreza MD*; Bajoghli, Hafez MD; Brand, Serge PhD

doi: 10.1097/YCT.0b013e31824b64b5
Original Studies

Objectives 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.

Methods 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).

Results Manic episodes as assessed by the Young Mania Rating Scale and CGI improved significantly over time and irrespective of group (target vs control group).

Conclusions 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.

From the *Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan; †Psychiatry and Psychology Research Center (PPRC), Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran; and ‡Depression and Sleep Research Unit, Psychiatric Hospital of the University of Basel, Basel, Switzerland.

Received for publication November 26, 2011; accepted January 16, 2012.

Reprints: Serge Brand, PhD, Depression and Sleep Research Unit, Psychiatric Hospital of the University of Basel, Wilhelm Klein-Strasse 27, 4012 Basel, Switzerland (e-mail:

All authors declare no conflicts of interest, and the study has been conducted without external funding.

The present work is the doctoral thesis of Gholamreza Bigdelou.

© 2012 Lippincott Williams & Wilkins, Inc.