Mood Stabilizer While Using ECT?
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Q:  Mood Stabilizer While Using ECT?

You seem to be in favor of mood stabilizers over antidepressants. My questions is that since I have been having ECT I have not been on a mood stabilizer because I have negative side effects from anti-psychotics and most of the other mood stabilizers either cause dileriums (lithium) or are anti-convulsants which defeats the whole purpose of ECT. I am currently on lexapro 20 mg and Wellbutrin SR 200mg (100mg 2x daily). Do you have any suggestions about a mood stabilizer that I can take while having ECT? The plan currently is to continue ECT for 1 1/2 years as a maintanence treatment.

Thank you,

Hello Ms. T' -- 
Well, first I'd have to figure my way through the logic of maintenance antidepressants (2) while using maintenance ECT.  Now ECT is not something I do, so I have no experience with the challenge of trying to keep maintenance sessions to a minimum, so maybe this is a great idea.  At the same time, I have two patients who relapsed into bipolar or bipolar-like symptoms within 2 weeks after a full, successful course of ECT, when placed immediately afterward on an antidepressant (1).  I have wondered how they would have fared with a mood stabilizer, or short of that, maybe just nothing.  Would they have made it a little longer?  After all, ECT is a great antidepressant; it's cycling prevention that's the challenge after a good outcome, no?  

A quick literature search using the terms "bipolar ECT maintenance" on Pub Med yielded a few interesting articles but only 35 total (often on such searches there are far more, so this says something about how much we have to go on). Here are some highlights: 

  • a specific article on this issue, comes up 3rd on the list, but it's dated, more than 10 years old now (if there was something similar but more recent it should have appeared higher on the list); note the conclusion that mood stabilizers helped the patients move from maintenance ECT to medication maintenance, but it's only three elderly patients...
  • this one just says ECT is good in this role, but if you dig up the article itself (via your local librarian, if needed) it might say what med's they were taking with their (effective) ECT;
  • this review from 5 years ago will show you sort of the state of the art, i.e. it isn't very far along, on this question.

You'd probably enjoy looking at the results of that search, so try it yourself via Pub Med if you like. 

Dr. Phelps

Published February, 2003


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