ECT beyond unipolar major depression: systematic review and meta‐analysis of electroconvulsive therapy in bipolar depression

Objective In this systematic review and meta‐analysis, the response, remission, and speed of response in adults with major depressive disorder (MDD) and bipolar disorder in depressive episode (BDD) receiving an acute course of electroconvulsive therapy (ECT) were quantitatively analyzed. Methods Usi...

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Bibliographic Details
Published in:Acta psychiatrica Scandinavica 2019-03, Vol.139 (3), p.214-226
Main Authors: Bahji, A., Hawken, E. R., Sepehry, A. A., Cabrera, C. A., Vazquez, G.
Format: Article
Language:English
Subjects:
Bipolar disorder
Bipolar Disorder - therapy
Depressive Disorder, Major - therapy
Depressive Disorder, Treatment-Resistant - therapy
Electroconvulsive Therapy
Humans
major depressive disorder
Mental depression
Meta-analysis
Outcome Assessment, Health Care
Remission
Remission Induction
Response rates
Systematic review
treatment‐refractory depression
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Summary:Objective In this systematic review and meta‐analysis, the response, remission, and speed of response in adults with major depressive disorder (MDD) and bipolar disorder in depressive episode (BDD) receiving an acute course of electroconvulsive therapy (ECT) were quantitatively analyzed. Methods Using the Preferred Reporting Items for Systematic Reviews and Meta‐analysis guidelines, 1660 citations were identified through five electronic databases. Nineteen articles met final inclusion criteria for meta‐analysis. Results The pooled response and remission rates with ECT in MDD were 74.2% (n = 1246/1680) and 52.3% (n = 850/1626), respectively. In BDD, they were 77.1% (n = 437/567) and 52.3% (n = 275/377), respectively. Although response rates to ECT were statistically higher in BDD (OR = 0.73, 95% CI: 0.56–0.95, P = 0.02), remission rates were similar (OR = 0.91, 95% CI: 0.65–1.26, P = 0.56). Individuals with BDD vs. MDD required fewer number of ECT sessions to achieve response (SMD = −0.23, 95% CI: −0.44 to −0.023, P = 0.03). There were no significant moderator effects identified. Conclusion Response rates and speed of response are higher in individuals with BDD; however, remission rates are equivalent. These findings support increased utilization of ECT in individuals with treatment‐refractory BDD.
ISSN:0001-690X
1600-0447
DOI:10.1111/acps.12994