background The greatest unmet need in the clinical management of bipolar disorder is the acute and long-term treatment of depressive symptoms. There is growing evidence to discourage the use of antidepressants in the treatment of bipolar depression, because of poor effectiveness and possible destabilising effects, with patients failing to achieve full remission.
aim To provide an overview of recent scientific data on the efficacy of ect in bipolar depression.
methods Apart from a review of the recent published evidence, the results of a randomised trial comparing ultrabrief pulse ect in 64 unipolar and bipolar patients will be discussed. Speed of response and remission in unipolar and bipolar patients is analysed.
results Patients with bp and up depression do not differ in rates of response or remission following an ect course. Patients with bp depression, however, showed a more rapid response than patients with up depression, thus needing less treatments.
conclusion Treatment of bipolar depression is a major challenge to the clinician. Since patients with bipolar depression do respond to ect as good as, and perhaps faster than patients with unipolar depression, ect should be considered earlier in the treatment course.