Role of adjunctive nonpharmacological strategies for treatment of rapid-cycling bipolar disorder

Table 1 Studies of adjunctive electroconvulsive therapy in rapid-cycling bipolar disorder

Ref.	Sample	Results
Case reports
Berman and Wolpert[56], 1987	18-yr-old woman with medication-resistant RCBD	ECT during mania led to complete remission, which was maintained for 14 mo without medications
Mizukawa et al[57], 1991	81-yr-old woman with medication-resistant ultra-RCBD	ECT did not prevent the recurrence of episodes over a period of 35 yr of observation
Benjamin and Zohar[58], 1992	45-yr-old man with treatment-resistant RCBD	Depressive episodes responded transiently to total sleep deprivation and psychotherapy but complete remission was only achieved with acute ECT
Kho[59], 2002	79-yr-old woman with medication-resistant RCBD	ECT and lithium was used successfully during acute and maintenance treatment
Zavorotnyy et al[60], 2009	63-yr-old woman with medication-resistant bipolar disorder	The patient developed ultra-rapid cycling during acute ECT, which responded to the continuation of ECT and addition of lithium
Amino et al[61], 2011	63-yr-old woman with medication-resistant RCBD	Continuation-ECT for 12 mo prevented rehospitalization
Huber and Burke[62], 2015	67-year-old woman with medication-resistant ultra-RCBD	ECT was used to successfully treat depression and manic episodes that developed on discontinuation of lithium
Kranaster et al[63], 2017	21-yr-old woman with medication-resistant ultra-RCBD	ECT was used to successfully treat a treatment-resistant depressive episode
Observational studies
Kukopulos et al[64], 1980	87 patients with RCBD	11 patients treated only with ECT for 7–35 yr remained in remission for long periods
Kukopulos et al[65], 1983	87 patients with RCBD	ECT was more effective than antidepressants in treating severe depression and when combined with lithium led to longer remissions
Wehr et al[66], 1988	24 patients with medication-resistant RCBD	None of the patients remitted with ECT
Mosolov and Moshchevitin[67], 1990	8 patients with mood stabilizer-resistant RCBD	Acute ECT lead to remission for 6 mo in 3 patients. The number of episodes and the time spent in mood episodes was reduced. Mood stabilizers were more effective following acute ECT treatment
Vanelle et al[68], 1994	Four patients with medication-resistant RCBD	Maintenance ECT for 18 mo led to full or partial remission in all 4 patients. Time spent in the hospital was reduced. Response was better in depressive episodes with psychotic symptoms
Wolpert et al[69], 2013	Six patients with continuous cycling	ECT started early in the course of cycling was effective in reducing recurrences
Koukopoulos et al[70], 2003	43 patients of RCBD who received ECT	11 patients remitted with ECT and mood stabilizer combinations and maintained in this state for 2–36 yr. Temporary improvement was noted in the others. Two out of 3 patients on maintenance ECT had good response
Minnai et al[71], 2011	14 patients with medication-resistant RCBD treated with maintenance ECT. Comparisons of 2-yr periods before and after ECT	All patients improved. Eight did not relapse over 2 yr and 6 had only one episode annually. Time spent ill was reduced and interepisodic periods were longer. Young males with type II BD and hyperthymic temperament had better outcome
Mosolov et al[72], 2021	1-year prospective study of 30 patients with RCBD and ultra RCBD with poor response to mood stabilizer treatment. Comparisons of 1-yr periods before and after acute ECT	40% achieved and maintained remission with ECT and lithium treatment; 30% showed partial response with the combination and 30% did not respond. Duration of mood episodes was significantly reduced with ECT. Mixed depression with/without catatonia had better response to acute ECT

ECT: Electroconvulsive therapy; RCBD: Rapid-cycling bipolar disorder; type II BD: Bipolar disorder type II; Ultra-RCBD: Ultra-rapid-cycling with shorter cycles of days to weeks; Ultradian-RCBD: Ultradian rapid-cycling with episodes lasting less than a day.