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J Affect Disord. 2016 May;195:180-4. doi: 10.1016/j.jad.2016.02.027. Epub 2016 Feb 11.

What happens to the course of bipolar disorder after electroconvulsive therapy?

Author information

Psychiatry Unit, San Martino Hospital - Health Agency N. 5, Oristano, Sardinia, Italy.
Section of Psychiatry, Department of Public Health, Molecular and Clinical Medicine, University of Cagliari, Sardinia, Italy; Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada.
Lucio Bini Mood Disorder Center, Rome, Italy; Lucio Bini Mood Disorder Centers, Cagliari, Italy; Department of Psychiatry, Harvard Medical School, Boston, MA, USA. Electronic address:



Bipolar disorder (BD) encompasses manic and depressive episodes and an illness-free interval. Treatments used in BD patients may influence the ill phases with different actions on the illness-free interval.


We performed a naturalistic mirror-image retrospective study analyzing the number of episodes and admissions in 41 BD patients for the same period of time of 5 years before and after electroconvulsive therapy (ECT). Furthermore, we assessed the duration of free intervals before and after ECT as a sign of prolonged well-being. Univariate analysis with t-test was used to compare differences before and after ECT, while analysis of variance was used to compare factors possibly associated with the efficacy on free-interval of ECT.


Comparing the 5-year periods before and after ECT, we found significantly longer [13.2 ± 9.0 months before ECT to 25.1 ± 19.1 after treatment (t=3.8; p<0.0001)] free intervals, as well as significant reductions in the number of episodes [5.9 ± 3.0 before ECT to 1.0 ± 1.7 after treatment (t=9.3; p<0.0001)], and in the number of admissions [2.2 ± 1.3 before ECT to 0.2 ± 0.5 after treatment (t=9.4; p<0.0001)].


The main limitations of this study consisted in the relatively small sample size, the mirror-image retrospective naturalistic study design and possibly patient selection bias.


Electroconvulsive therapy seemed to increase free-intervals and reduced number of BD episodes and admissions. It is plausible that ECT, along with suspending antidepressant treatment, might carry intrinsic stabilizing effect on the course of BD.


Antidepressants; Bipolar disorder; Clinical course; ECT; Free interval; Mood stabilizers

[Indexed for MEDLINE]

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