Treatment of Electroconvulsive Therapy–Emergent Hypomania and Mania

Abstract

Objective: Electroconvulsive therapy (ECT) emergent hypomania/mania is a clinically significant problem which 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 between 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 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 nine patients, who had no known history of manic or hypomanic episodes and were diagnosed with unipolar depression, and eight patients diagnosed with bipolar disorder. There were four 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. Conclusion: The available data is insufficient to support definitive conclusions, however, potential treatment guidelines are suggested within the review to providers based on the limited data available.