Results of a large study funded by the National Institute of Mental Health showed that electroconvulsive therapy (ECT) might be equally effective in both patients with unipolar depression and those with bipolar depression. The study, led by Samuel H. Bailine, MD, assistant professor in the department of psychiatry and behavioral sciences at Zucker Hillside Hospital, Glen Oaks, NY, showed that the remission rate in both patient groups was higher than 60%.1
The authors sought to clarify the role of ECT in the treatment of bipolar depression in this randomized, double-masked, controlled trial, which included 220 patients. Of these patients, 170 had unipolar depression and 50 had bipolar depression. Almost all patients had not responded to treatment with multiple trials of medication.
Remission was defined as a total score of 10 or less using the 24-item Hamilton Rating Scale for Depression (HAM-D) and a 60.0% reduction of score from baseline. Patients received ECT 3 times weekly. While no minimum or maximum number of ECT sessions was set, patients who discontinued treatment before 10 sessions were considered to be dropouts.
In all patients studied, the remission rate was 61.8%. A reduction in HAM-D scores of at least 50% was shown in 78.8% of patients with unipolar depression and 80.0% of patients with bipolar depression.
The authors concluded that guidelines for the treatment of unipolar and bipolar depression minimize the role of ECT. Based on the results of this study, they encourage physicians to consider the efficacy of ECT when treating patients with unipolar depression and bipolar depression. They also suggest that treatment algorithms should be modified.
