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Electroconvulsive therapy in bipolar depression - effectiveness and prognostic factors

Journal article
Authors K. Popiolek
S. Beierot
O. Brus
A. Hammer
Mikael Landén
J. Lundberg
P. Nordanskog
A. Nordenskjold
Published in Acta Psychiatrica Scandinavica
Volume 140
Issue 3
Pages 196-204
ISSN 0001-690X
Publication year 2019
Published at Institute of Neuroscience and Physiology
Pages 196-204
Language en
Keywords bipolar disorders, bipolar depression, electroconvulsive therapy, prognosis, short-term response, major depression, remission, ect, resistance, unipolar, metaanalysis, predictors, consortium, efficacy, Psychiatry
Subject categories Psychiatry


Objective Electroconvulsive therapy (ECT) is used in patients with severe forms of bipolar depression. ECT is effective but not all patients respond. The aim of this study was to determine prognostic factors for response to ECT in patients hospitalized for bipolar depression. Methods Data were obtained from several national Swedish registers. All patients with bipolar depression treated with ECT in any hospital in Sweden between 2011 and 2016 for whom information about ECT response was available were included (n = 1251). Response was defined as a score on the Clinical Global Impression - Improvement scale of one or two. Univariate and multivariate logistic regression were conducted to investigate associations between socio-demographic and clinical factors and response. Results Response was achieved in 80.2% patients. Older age was associated with higher response rate to ECT. Patients with comorbid obsessive-compulsive disorder or personality disorder, and patients previously treated with lamotrigine had lower response rate. Conclusion Electroconvulsive therapy for bipolar depression was associated with very high response rates. The strongest prognostic factors were higher age, absence of comorbid obsessive-compulsive disorder or personality disorder, and less prior pharmacologic treatment.

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