This material was presented in the 25th European Congress of Psychiatry which was organised by the European Psychiatry Association in Florence, Italy from 1-4th April 2017. I had access to the material as I attended the full Congress. Please note that this material remains the intellectual property of the European Psychiatry Association and its authors and any citation should include a full reference to it. For more information on the EPA and how to become a member, please visit: http://www.europsy.net/

1. .
No potential conflict of interest
Abstract Number: EPA17-2500
Manic switch in Bipolar patients treated with
Electroconvulsive Therapy for Treatment-Resistant Depression:
the experience at the Mood Disorder Unit of Milan (Italy)
Delmonte D*, Brioschi S**, Locatelli C*, Barbini B*, Franchini L*, Colombo C**
*IRCCS San Raffaele-Turro Hospital,
**Vita-Salute San Raffaele University
Aims: Despite appropriate treatment, 30-40% of
depressed patients, both unipolar and bipolar, don’t
achieve improvement, with high morbidity and
mortality. For bipolar patients another risk is the
switch into mania due to antidepressant treatment.
The concern about the switch suggests to
administer antidepressants at lower doses, in
combination with mood stabilizers and second
generation antipsychotics. We performed an
observational study on a sample of 23 bipolar
patients treated with ECT for severe TRD in last 3
years, in order to evaluate the risk of switch with
this therapy.
Objectives: 23 bipolar inpatients undergoing
bitemporal ECT twice/week with MECTA spectrum
device. Main demographic and clinical data
collected. Course of illness monitored with
Hamilton Rating Scale for Depression (HAM-D).
Clinical response defined as 50% reduction of
HAM-D score at the endpoint from baseline;
remission as HAM-D score at the endpoint <8.
Young Mania Rating Scale (YMRS) weekly in
order to assess switch into mania.
Results. 13(56.5%) females, 10(43.5%) males,
mean age 60.1±10.3years. Mean age at onset
35.5±13.6years. Mean number of episodes:
7.1±3.6. Mean duration of current episode:
33.4±24.9 weeks. Mean HAM-D basal score:
30.0±5. Each patient underwent a cycle of ECT
(mean N°6.7±3.3). Pharmacological treatment
was administered upon clinical need. Response rate
was 87%; remission rate was 43.5%.
3/23(13.04%) patients had transient hypomanic
switch, spontaneous recovery within 7 days after
the last ECT.
• Truman CJ, et al. Self-reported history of manic/hypomanic switch associated with antidepressant use: data from the Systematic Treatment
Enhancement Program for Bipolar Disorder (STEP-BD). J Clin Psychiatry 2007; 68: 1472–9.
• American Psychiatric Association The practice of electroconvulsive therapy: recommendations for treatment, training and privileging – a
task force report, 2nd ed Washington DC: American Psychiatric Press, 2001.
Conclusions. Our experience confirms that ECT is a powerful antidepressant, especially in patients with
severe long-lasting depression, refractory to treatment, both unipolar and bipolar ones. ECT is also a safe
procedure: no adverse effects were reported. The manic switch rate is low, as suggested in literature,
lower than the risk with antidepressant drugs.