Response to ECT in depressive subtypes and mixed state

Objectives Available literature data suggest the efficacy of electroconvulsive therapy (ECT) in a large spectrum of depressive disorders, but the results often turn-out to be in contrast with each other. We explored differences of response to ECT in unipolar depression, bipolar depression and mixed state in a sample of patients resist- ant to pharmacological treatment. Methods 130 patients (17 with major depressive disorder (UP), 67 with major depressive episode in bipolar disorder type II (BP II), 46 with major depressive episode in bipolar disorder type I (BP I) and 50 with mixed state (MS) according to the DSM-IV crite- ria) were included in the study and treated with bilateral ECT, on a twice-a-week schedule. The patients were assessed before (baseline) and one week after the ECT course (final score), using the Hamilton Rating Scale for Depression (HAM-D), Young Mania Rating Scale (YMRS), Brief Psychiatric Rating Scale (BPRS) and the Clinical Global Impressions scale (CGI). Results The four groups (UP, BP II, BP I and MS) showed a significant improvement after the ECT course with comparable response rates in all groups. Remission rate, evaluated with the CGI and the HAM-D scales, was significantly higher in UP compared to the other 3 groups. Conclusions ECT should not be disregarded as an effective therapeutic option for the treatment of unipolar and bipolar depressive and mixed pa- tients resistant to pharmacological treatment. MS and BP I tended to exhibit more residual agitation and psychotic features than UP