ECT in Mania: Meta-Analysis of ECT Plus Meds vs Meds Alone

 Out on PubMed from researchers from China and Cleveland, Ohio, is this meta-analysis:

Efficacy and safety of electroconvulsive therapy plus medication versus medication alone in acute mania: A meta-analysis of randomized controlled trials.

Zhang J, Wang G, Yang X, Gao K.Psychiatry Res. 2021 May 19;302:114019. doi: 10.1016/j.psychres.2021.114019. Online ahead of print.PMID: 34058715 

The abstract is copied below:

Although some studies have reported the potential efficacy of electroconvulsive therapy (ECT) in the treatment of acute mania, there is no consensus on the matter. Therefore, we performed a meta-analysis to determine the efficacy and safety of ECT combination with medication (ECT-combo) vs. medication alone (Med-alone) in the treatment of acute mania. Randomized controlled trials (RCTs) of ECT-combo versus Med-alone in acute mania were searched in Chinese databases and English databases from their inceptions up to February 2020. Twelve RCTs (including 863 patients, n=863) met our criteria and were included into meta-analysis. The pooled results found that ECT-combo outperformed Med-alone in reducing manic symptoms from baseline to endpoint with a standardized mean difference of -3.50 (95% CI: -4.57, -2.44, p<0.00001). The significant difference occurred after 3-5 treatments or after a 1-week treatment. ECT-combo had significantly increased memory impairment compared to Med-alone. Apart from increased memory impairment in ECT-combo group (SMD=8.33; 95% CI: 2.73 to 25.45, p= 0.0002), no other statistically significant differences in side effects or drop-out rates were found between groups. The results of this meta-analysis suggest that ECT-combo was significantly superior to Med-alone in efficacy and well-tolerated as Med-alone in the acute treatment of mania. However, larger studies with randomized, double-blind design, and standardized treatment regimens are still warranted due to the high heterogeneity of studies included in the present meta-analysis.

Keywords: Bipolar disorder; ECT; Medication; Mood stabilizer; RCT; Review.

And from the text:

Conclusions:

ECT-combo outperformed Med-alone in reducing acute manic symptoms in patients with bipolar I disorder. ECT was well tolerated with minimal side effects. With its faster onset of antimanic action, the role of ECT in acute mania needs to be re-evaluated. Large multi-center, randomized, controlled trials with a high-quality design are essential to provide reliable results for evidence-based practice of ECT in acute mania. 

This meta-analysis is interesting and worthwhile because it involves ECT for mania, a grossly understudied subject. That said, its conclusions may not be generalizable, since all but one of the studies were conducted in China. Nonetheless, the finding of more rapid and better response to ECT+meds than meds alone is helpful to have documented in the literature. Of course, the other (non)finding is that there is very little about this topic in the English-language literature; the authors plea for more research is well taken. For those interested in ECT for mania, a full read may be worthwhile, ~20 minutes.