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

Abstract

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 Title

Can Electroconvulsive therapy help in the First Episode of Mania?

Plain Language Summary

Bipolar disorder is a mental health condition where people experience episodes of mania and depression. Mania involves increased energy, reduced need for sleep, irritability, aggression, or even psychotic symptoms such as delusions and hallucinations. When someone experiences their first episode of mania (FEM), it is often a psychiatric emergency that requires fast and effective treatment. Electroconvulsive therapy (ECT) is a treatment where controlled electrical stimulation is given to the brain under anaesthesia. It has been used for decades to treat severe mental illnesses, particularly when symptoms are very severe or medications do not help enough. However, very little is known about how ECT works for FEM, particularly in India, where ECT is widely used. We reviewed hospital records of patients with FEM admitted to the National Institute of Mental Health and Neurosciences (NIMHANS), India, between 2008 and 2011. Among 213 patients, 81 received ECT, and we analysed 63 with complete records. Most were young adults in their early 20s, and many had aggression, psychosis or restlessness. ECT was usually started within the first week of admission, mainly for aggression, catatonia, or urgent need for improvement. Patients typically received 5–6 sessions. The results showed that ECT worked well: about 9 out of 10 patients improved significantly, with many becoming symptom-free within 4 weeks. Side effects were rare and mild, such as brief memory problems or minor injuries. Only one in four patients experienced mania coming back within a year. These findings suggest that ECT can be a safe and effective option for managing FEM, particularly in urgent or severe cases. More research is needed to confirm its long-term benefits, but this study adds important evidence supporting the use of ECT early in the course of bipolar disorder.