Advantages of Early ECT in Bipolar Disorder: New Data From Japan

 Out on PubMed, from investigators in Japan, is this study:

Early electroconvulsive therapy in patients with bipolar depression: A propensity score-matched analysis using a nationwide inpatient database.

Yamazaki R, Ohbe H, Matsuda Y, Kito S, Shigeta M, Morita K, Matsui H, Fushimi K, Yasunaga H.J Affect Disord. 2022 Jun 24:S0165-0327(22)00720-0. doi: 10.1016/j.jad.2022.06.060. Online ahead of print.PMID: 35760194



The abstract is copied below:

Objectives: Electroconvulsive therapy (ECT) is a widely used treatment for bipolar depression; however, evidence of its effectiveness is not sufficient. This study therefore aimed to evaluate whether early ECT is associated with reduced length of hospital stay.


Methods: In this retrospective cohort study using the Japanese Diagnosis Procedure Combination database, we identified patients admitted for bipolar depression between April 2010 and March 2018. The primary outcome was length of hospital stay, and the secondary outcome was clinical outcomes and total hospitalization costs. Propensity score-matched analyses were performed to compare the outcomes between patients who received ECT within 8 days of admission (early ECT group) and those who did not (control group).

Results: We identified 5941 eligible patients, comprising 219 in the early ECT group and 5722 in the control group. After 1:4 propensity score matching, patients in the early ECT group had significantly shorter lengths of hospital stay than those in the control group (53 days in the early ECT group and 73 days in the control group; difference: -20.2 days; 95 % confidence interval: -29.2 to -11.2 days). There was no significant difference in total hospitalization costs between the two groups. In-hospital mortality and fatal complications were rare in both groups. The result was similar in the sensitivity analysis using inverse probability of treatment weighting.

Limitations: Our study was limited by retrospective design and the possibility of unmeasured confounders.

Conclusions: Early ECT was associated with reduced length of hospital stay without increasing total hospitalization costs in patients with bipolar depression.

Keywords: Bipolar depression; Electroconvulsive therapy; National database; Propensity score matching; Retrospective study.

The article is here.

And from the text:





This is an important register-based study from Japan. The clear and simple results are shorter hospital stay without increased cost with early implementation of ECT for bipolar depression. 
What just a few short years ago was a an evidence desert for ECT in bipolar disorder is now blossoming. But of course there was never any reason to think that bipolar depression would respond less well to ECT than unipolar depression (MDD). (Yamazaki and colleagues published similar data for MDD in JECT, Sept. 2021, volume 37, pp.171-181)




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