Electroconvulsive therapy in treatment resistant bipolar disorder — Case reports

ObjectiveThis paper aims to review the available evidence for the use of clozapine and electroconvulsive therapy (ECT) in combination.MethodologyElectronic searches were carried out to identify reports describing the combined use of clozapine and ECT.ResultsForty reports including 208 patients were identified. The majority of reports were in the form of case reports and case series, with few retrospective and open-label studies. The majority of patients were aged between 18 and 65 years and diagnosed with schizophrenia or schizoaffective disorder. Most of the patients refractory to clozapine were started on ECT as an augmentation therapy; however, in some reports, both ECT and clozapine were started concurrently, and in few cases clozapine was started after ECT. In terms of effectiveness, 37.5–100% patients improved in short-term, and sustained long-term improvement (3 weeks to 24 months) was described in few studies. In terms of the side-effect profile, five patients each had delirium and tachycardia and only four patients were described to have prolonged seizures. Overall, the combination was considered effective and safe.ConclusionThere is evidence for the effectiveness and safety of the clozapine–ECT combination and it should be used in patients with treatment-resistant schizophrenia who do not respond to clozapine.

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The role of electroconvulsive therapy in the treatment of bipolar disorder

10.1093/med/9780198748625.003.0027 ◽

2017 ◽

Author(s):

Roumen Milev

Keyword(s):

Bipolar Disorder ◽

Electroconvulsive Therapy ◽

Case Reports ◽

Bipolar Disorders ◽

Seizure Threshold ◽

Randomized Control Trials ◽

Mixed States ◽

Everyday Clinical Practice ◽

Randomized Control

This chapter examines the use of electroconvulsive therapy (ECT) for treatment of patients with bipolar disorders. It briefly reviews the basics of ECT, stimulus parameters, placement of electrodes, and seizure threshold. The data for efficacy and tolerability of ECT for bipolar disorder, including mania, depression, mixed states, and across the lifespan is reviewed. Although there is a paucity of good-quality randomized studies, all available data, including case reports and naturalistic observations, support the use of ECT in this population, and reinforce the widespread use of ECT in everyday clinical practice. Good-quality randomized control trials are urgently needed to address numerous unanswered questions, in order to improve efficacy and reduce side-effect burden of one of the best treatments for bipolar disorder.

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Successful bilateral electroconvulsive therapy in a patient with a seizure disorder taking levetiracetam, lorazepam, and zonisamide: A case report

Mental Health Clinician ◽

10.9740/mhc.2021.01.023 ◽

2021 ◽

Vol 11 (1) ◽

pp. 23-26

Author(s):

Ian R. McGrane ◽

Rachel E. Tenison ◽

Dana M. Bimler ◽

Robert C. Munjal ◽

Jason R. Molinaro

Keyword(s):

Bipolar Disorder ◽

Electroconvulsive Therapy ◽

Extended Release ◽

Medication Management ◽

Immediate Release ◽

Seizure Threshold ◽

Treatment Resistant ◽

Evening Dose ◽

Patients With Epilepsy ◽

Higher Doses

Abstract Electroconvulsive therapy (ECT) may be considered for treatment of severe, treatment-resistant, and emergent depression associated with MDD or bipolar disorder. Patients with epilepsy usually take medications that raise the seizure threshold, which poses challenges during ECT. We report a 66-year-old male with epilepsy taking levetiracetam extended-release (XR), lorazepam, and zonisamide requiring ECT for severe MDD. After literature review, the XR form of levetiracetam was changed to higher doses of the immediate-release (IR) formulation, and zonisamide was discontinued 2 days prior to ECT in the hospital and was resumed when the patient underwent outpatient continuation ECT. The patient was treated to remission after receiving 8 acute bilateral ECT treatments before being transitioned to continuation ECT. We provide a brief review of medication management of antiepileptic drugs and other medications that increase the seizure threshold during ECT. To our knowledge, this is the first reported case describing the management of levetiracetam, lorazepam, and zonisamide concomitantly during ECT. Our case suggests that utilizing the IR formulation of levetiracetam, administering the evening dose early the day prior to the procedure, and temporarily discontinuing zonisamide prior to bilateral ECT is effective for the treatment of severe MDD while maintaining seizure prophylaxis.

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The study protocol of the Norwegian randomized controlled trial of electroconvulsive therapy in treatment resistant depression in bipolar disorder

BMC Psychiatry ◽

10.1186/1471-244x-10-16 ◽

2010 ◽

Vol 10 (1) ◽

Cited By ~ 15

Author(s):

Ute Kessler ◽

Arne E Vaaler ◽

Helle Schøyen ◽

Ketil J Oedegaard ◽

Per Bergsholm ◽

...

Keyword(s):

Bipolar Disorder ◽

Randomized Controlled Trial ◽

Electroconvulsive Therapy ◽

Study Protocol ◽

Controlled Trial ◽

Treatment Resistant Depression ◽

Treatment Resistant ◽

Randomized Controlled ◽

Resistant Depression

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P01-49 - The study protocol of the Norwegian randomized controlled trial of electroconvulsive therapy in treatment resistant depression in bipolar disorder

European Psychiatry ◽

10.1016/s0924-9338(10)70268-6 ◽

2010 ◽

Vol 25 ◽

pp. 269

Author(s):

U. Kessler ◽

H. Schøyen ◽

A. Vaaler ◽

K. Ødegaard ◽

P. Bergsholm ◽

...

Keyword(s):

Bipolar Disorder ◽

Randomized Controlled Trial ◽

Electroconvulsive Therapy ◽

Study Protocol ◽

Controlled Trial ◽

Treatment Resistant Depression ◽

Treatment Resistant ◽

Randomized Controlled ◽

Resistant Depression

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Catatonia Development in a Patient with Bipolar Disorder Following Electroconvulsive Therapy: A Case Report

Iranian Journal of Psychiatry ◽

10.18502/ijps.v14i1.429 ◽

2019 ◽

Cited By ~ 2

Author(s):

Azadeh Mashayekhi ◽

Alireza Ghayoumi

Keyword(s):

Bipolar Disorder ◽

Case Report ◽

Electroconvulsive Therapy ◽

Case Reports ◽

Precipitating Factors ◽

Psychotic Feature ◽

History Of ◽

B12 Deficiency ◽

Major Treatment ◽

Long Acting

Objective: Electroconvulsive therapy (ECT) is a major treatment of catatonia; and catatonia development during electroconvulsive therapy is a highly surprising phenomenon. We present a patient with bipolar disorder who developed catatonia during ECT. Case Reports: A 21-year-old woman, with a known case of bipolar disorder in manic phase without psychotic feature, history of long acting antipsychotic use, and severe B12 deficiency, was treated with ECT. Full catatonia syndrome developed after the fifth session of ECT. Conclusion: In rare cases, catatonia can develop during ECT course in the presence of some precipitating factors. Thus, these precipitating factors should be eliminated as much as possible before the start of ECT course to prevent catatonia development.

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Disturbance of Oxidative Stress Parameters in Treatment-Resistant Bipolar Disorder and Their Association With Electroconvulsive Therapy Response

The International Journal of Neuropsychopharmacology ◽

10.1093/ijnp/pyaa003 ◽

2020 ◽

Vol 23 (4) ◽

pp. 207-216 ◽

Cited By ~ 1

Author(s):

Qinyu Lv ◽

Qiongyue Hu ◽

Wenzhong Zhang ◽

Xinxin Huang ◽

Minghuan Zhu ◽

...

Keyword(s):

Oxidative Stress ◽

Bipolar Disorder ◽

Electroconvulsive Therapy ◽

Rating Scale ◽

Enzyme Linked Immunosorbent Assay ◽

Treatment Resistant ◽

Young Mania ◽

Hamilton Depression Rating Scale ◽

Oxidative Stress Parameters ◽

Stress Parameters

Abstract Objective Electroconvulsive therapy (ECT) is an effective option for treatment-resistant bipolar disorder (trBD). However, the mechanisms of its effect are unknown. Oxidative stress is thought to be involved in the underpinnings of BD. Our study is the first, to our knowledge, to report the association between notable oxidative stress parameters (superoxide dismutase [SOD], glutathione peroxidase [GSH-Px], catalase [CAT], and malondialdehyde [MDA]) levels and ECT response in trBD patients. Methods A total 28 trBD patients and 49 controls were recruited. Six-week ECT and naturalistic follow-up were conducted. SOD, GSH-Px, CAT, and MDA levels were measured by enzyme-linked immunosorbent assay, and the 17-item Hamilton Depression Rating Scale and Young Mania Rating Scale were administered at baseline and the end of the 6th week. MANCOVA, ANCOVA, 2 × 2 ANCOVA, and a multiple regression model were conducted. Results SOD levels were lower in both trBD mania and depression (P = .001; P = .001), while GSH-Px (P = .01; P = .001) and MDA (P = .001; P = .001) were higher in both trBD mania and depression compared with controls. CAT levels were positively associated with 17-item Hamilton Depression Rating Scale scores in trBD depression (radjusted = 0.83, P = .005). MDA levels in trBD decreased after 6 weeks of ECT (P = .001). Interestingly, MDA levels decreased in responders (P = .001) but not in nonresponders (P > .05). Conclusions Our study indicates that decreased SOD could be a trait rather than a state in trBD. Oxidative stress levels are associated with illness severity and ECT response. This suggests that the mechanism of oxidative stress plays a crucial role in the pathophysiology of trBD.

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