RIGHT UNILATERAL ELECTROCONVULSIVE THERAPY FOR THE TREATMENT OF LATE-LIFE BIPOLAR DISORDER

Abstract

Introduction Bipolar Disorder accounts for 10-25% of all mood disorders in the geriatric population and 5% of all inpatient admissions to geropsychiatric units. It is a disabling illness in the elderly and is often treatment-resistant. Electroconvulsive therapy (ECT) is an effective treatment for all phases of bipolar disorder, though only a few studies have focused on bipolar disorder in the geriatric population. There is insufficient evidence to determine which electrode placement is most efficacious in treating bipolar disorder. Some experts recommend the use of bilateral treatments. However, no evidence-based data support this particular approach. The treatment of bipolar depression with ECT brings a set of challenges, most notably the concomitant use of anticonvulsants as mood stabilizers. The earlier practice of stopping all psychotropic medications before and during a course of ECT is no longer a common practice. However, there is controversy in the field and difference in opinion regarding the combination of antiepileptic drugs (AED), lithium and ECT. Another challenge of using ECT for the treatment of bipolar depression is the risk of inducing mania or modifying the illness to one that is rapid cycling, which could become more challenging to treat if no mood stabilizers are kept on board. This study will report on our experience treating late-life bipolar disorders with ECT in our high volume ECT service. Methods Forty-eight patients 55?years old and older with Bipolar Disorder who received right unilateral (RUL) ECT were identified on a retrospective chart review form the Emory University ECT service. 72% were female. Forty-four received ultra-brief pulse right unilateral (UBRUL), 4 received brief RUL. The cohort consisted of Bipolar Depression, Bipolar mania, Bipolar with psychotic features, and Bipolar with catatonia. Quick Inventory of Depressive Symptomatology (QIDS) was completed both pre-ECT and post-ECT, while the Clinical Global Impression–Improvement (CGI-I) scale was performed post-ECT. Response was defined by a decrease of QIDS by 50% and CGI-I ≤2. Results Analysis is undergoing; information regarding electrode placement modality, pulse width, use of mood stabilizers, response rates, remission rates, and cognitive function will be included in the results. We expect to have a high number of patients responding to UBRUL ECT. Conclusions ECT is a safe and effective treatment modality for patients presenting with Bipolar Disorder. RUL treatment modality could be considered as an option prior to BL ECT in order to decrease risks of cognitive adverse effects. Further studies are warranted to establish further treatment guidelines in this area. This research was funded by: No funding