Treatment of resistant mood and schizoaffective disorders with electroconvulsive therapy: A case series of 264 patients

Objectives Electroconvulsive therapy (ECT) is a non-pharmacological treatment whose effectiveness has been demonstrated for patients suffering from severe and resistant depression, bipolar disorder and schizophrenia. Several studies demonstrated the efficacy of ECT in different subgroups, such as patients with bipolar depression, mixed state, psychotic features and suicidal ideation. Herein we report a case series of 264 patients with mood and schizoaffective disorders who were resistant to multiple pharmacological trials and treated with ECT to achieve a clinical improvement or remission. Methods Patients underwent ECT at the psychiatric unit of Montichiari Hospital. All subjects had at least 18 years of age and met DSMIV TR criteria for major depressive disorder (n = 89, 33.7%), bipolar disorder (manic n = 5, 1.89%; mixed n = 17, 6.4%; depressed n = 92, 34.85%), mood disorder with catatonic features (n = 8, 3.03%) or schizoaffective disorder (n = 50, 18.94%). Patients were evaluated before treatment (T0) and at one week (T1), 6 months (T2) and 1 year (T3) after treatment with theClinical Global Improvement scale (CGI). Suicidal ideation was evaluated clinically at each follow-up visit. Results Clinical evaluations made one week after ECT showed clinical improvement in 100% of patients with manic episodes, 92% with bipolar depression, 91% with major depression, 90% with schizoaffective disorder, 82% with mixed episode and 62.5% with catatonic features. The same evaluation repeated 6 months and 1 year after the ECT reaffirmed global clinical improvement in 100% of manic patients, 88.5 with bipolar depression, 88% with mixed episode, 83.5% with major depression, 77% with schizoaffective disorder and 75% with catatonia. Conclusions ECT appears to be effective in providing overall clinical improvement. These conclusions are, however, limited by the experimental design and therefore liable to many uncontrolled variables.