Treatment of Electroconvulsive Therapy–Emergent Hypomania and Mania: A Systematic Review of the Literature

Alesia A. Cloutier, DO; Stephen J. Seiner, MD; Haley V. Solomon, DO; Shawn S. Jin, MD; Anderson Chen, MD; Arkadiy Stolyar, MD; Brent P. Forester, MD, MSc

J Clin Psychiatry 2022;83(1):21r13911

ABSTRACT

Objective: Electroconvulsive therapy (ECT)–emergent hypomania/mania is a clinically significant problem that has lacked evidence-based guidelines for effective management. The aim of this systematic literature review is to compile the current published literature on treating ECT-emergent hypomania/mania to help guide treatment course in patients with unipolar and bipolar depression.

Data Sources: MEDLINE/PubMed was searched for studies published from 1980 through August 2020 that evaluated the treatment of ECT-emergent hypomania/mania. Search terms included Boolean combinations of the following: mania, hypomania, ECT, ECT induced mania, and ECT induced hypomania.

Study Selection: There were 1,662 articles reviewed, and all published studies detailing the treatment of ECT-emergent hypomania/mania written in English that met inclusion criteria were included. Due to the limited number of articles, there were no restrictions.

Data Extraction: Two reviewers extracted relevant articles and assessed each study based on inclusion criteria.

Results: The literature review identified 12 articles that described the treatment course of ECT-emergent hypomania/mania in 17 patients. There were 9 patients who had no known history of manic or hypomanic episodes and were diagnosed with unipolar depression and 8 patients diagnosed with bipolar disorder. There were 4 primary treatment courses identified: continuing ECT alone, continuing ECT in conjunction with lithium, discontinuing ECT with no medication treatment, or discontinuing ECT and starting a medication.

Conclusions: The available data are insufficient to support definitive conclusions; however, potential treatment guidelines are suggested within the review to providers based on the limited data available.

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