Adjunctive Electroconvulsive Therapy for First Episode Mania: Data From a Tertiary Care Center in India: Électroconvulsivothérapie d'appoint en cas de premier épisode de trouble maniaque: Données provenant d'un centre de soins tertiaires en inde.

BACKGROUND

First Episode Mania (FEM) in Bipolar 1 Disorder (BD-1) often presents as a psychiatric emergency requiring rapid symptom control. While electroconvulsive therapy (ECT) is recommended for severe or treatment-resistant mania, its role in FEM has not been well studied, particularly in India, where ECT is widely practiced. This study aimed to examine the indications, parameters, acute response, safety, and first recurrence outcomes associated with ECT in FEM.

METHODS

We conducted a retrospective chart review of patients admitted with FEM at the National Institute of Mental Health and Neurosciences (NIMHANS), India, between 2008 and 2011. Of 213 patients with FEM, 81 (38%) received ECT along with pharmacotherapy; 63 with complete records were included in this study. Data on sociodemographic and clinical features, ECT parameters, indications, response, and recurrence were extracted. Response was defined as ≥ 75% improvement in manic symptoms, and remission as complete absence of symptoms for ≥ 8 weeks.

RESULTS

ECT was initiated within a mean of 8.7 days of admission, most often for aggression (66.7%), urgent need for improvement (51.6%), or augmentation of pharmacotherapy (27.4%). Patients received an average of 5-6 sessions, predominantly bitemporal (90.5%). Side effects were minimal, limited to transient oral injuries, prolonged seizures, or mild cognitive complaints in < 10%. Response was seen in 90.5%, with a mean time for remission of around 1 month. Among 45 patients with follow-up data, recurrence occurred in 24.4% within a year.

DISCUSSION: ECT was frequently used in FEM, driven by clinical severity and need for rapid response. It was found to be safe, and associated with high response rates. These findings suggest ECT may be a valuable early intervention in FEM, warranting prospective controlled studies.Plain Language Summary TitleCan Electroconvulsive therapy help in the First Episode of Mania?