Mental Health Disorders

Electroconvulsive Therapy Is Highly Effective in Some Patients With Bipolar Disorder

Electroconvulsive therapy (ECT) is highly effective at reducing suicide risk among patients with bipolar depression, according to a recent study.1

The researchers conducted a study of 670 patients with bipolar depression treated with ECT at the University of Pisa psychiatry clinic between January 2006 and July 2019 which assessed the relationship between ECT response and patient characteristics including age, sex, biopolar subtype, episode duration, mean seizure duration, Hamilton Depression Rating Scale (HAM-D) and Young Mania Rating Scale (YMRS) scores, psychomotor disturbances and psychotic symptoms assessed through the Brief Psychiatric Rating Scale (BPRS-EV).

“When we sampled the patients who came to us we found that around 93% had tried and failed with pharmacological treatment, 88% had failed on 2 different drugs. In fact, on average each patient who came to us had tried 5 different drugs, without success," said study author Giulio Emilio Brancati, MD, in a press release.2

Overall, 483 patients (72%) responded to treatment with ECT. Known factors that were associated with response included seizure duration, number of treatments, and episode duration. Putative factors associated with response included severe motor retardation, tension or agitation, hyperactivity, and delusions of guilt.

Of 77 patients who were considered to be at severe risk of suicide at baseline, only 2 remained at severe risk and 65 were no longer at risk of suicide following 2 treatments with ECT.

“Bipolar depressive patients with severe psychomotor disturbances, mood-congruent delusions and severe mixed features are highly responsive to ECT. A significant improvement in response prediction is expected when considering those clinical characteristics,” the researchers concluded.

—Michael Potts


  1. Brancati GE, Tripodi B, Novi M, et al. Association of treatment facets, severity of manic symptoms, psychomotor disturbances and psychotic features with response to electroconvulsive therapy in bipolar depression. Published online June 3, 2020. World J Biol Psychiatry. doi: 10.1080/15622975.2020.1770860
  2. Electroconvulsive therapy shown to significantly reduce suicide risk in Bipolar patients. News release. European College of Neuropsychopharmacology. September 12, 2020.