Electroconvulsive Therapy-Induced Mania in Bipolar Disorder: A Case Report

Electroconvulsive therapy (ECT) is widely recognized as a safe and effective intervention for treating severe affective episodes in patients with bipolar disorder. However, it can sometimes precipitate unexpected manic phases in patients treated for a depressive episode, a phenomenon known as ECT-induced mania. While this occurrence is recognized, it remains poorly understood and minimally addressed in the literature. This article presents a case study of a 56-year-old man diagnosed with bipolar I disorder with rapid cycling and late-onset features who received ECT to treat a severe depressive episode with psychotic and catatonic features but developed a manic episode with psychotic elements shortly after ECT initiation. The onset of mania coincided with the discontinuation of valproate, which may have further increased the likelihood of a mood switch. A literature review suggests four main clinical strategies for managing ECT-induced mania: (1) cessation of ECT, (2) cessation of ECT and initiation of pharmacotherapy, (3) continuation of ECT, and (4) continuation of ECT alongside the addition of lithium as a mood stabilizer. However, the limited and primarily case-based nature of existing research makes it challenging to establish universally applicable treatment guidelines. In the described case, treatment was modified by temporarily suspending ECT and introducing lithium, which helped stabilize the patient's manic symptoms. ECT was later resumed with lithium maintenance, achieving improved mood stability. This case highlights the complexities associated with ECT in bipolar disorder, particularly the potential for manic induction, especially when mood stabilizers are withdrawn. It underscores the need for rigorous patient assessment and monitoring, as well as further research to clarify optimal management strategies and preventive measures for ECT-induced mania.