Neuroversion: a possible mechanism of action of ECT in acute mania

Abstract

The first-line treatments for acute mania are lithium, antiepileptic moodstabilizers, and antipsychotic drugs. Electroconvulsive therapy (ECT) is reserved for drug-resistant patients, although it is the first-line treatment for severe or delirious mania with life-threatening physical exhaustion. Contrary to depression, there is a paucity of evidence for the use of ECT in acute mania. However, available literature indicates that ECT seems effective in treating acute mania, with response rates between 80% and 90%, even in drug-resistant patients. Yet, its electrophysiological and molecular pathways remain unknown. We present the curious case of a 63-year-old woman, followed at our psychiatric outpatient clinic for bipolar disorder type I, admitted to our inpatient unit in a manic state with psychotic features. Due to bradycardia episodes secondary to the psychiatric medication, she was submitted to ECT. After a single session, her symptoms improved, despite no evoked seizures. We compare this curious phenomenon to the well-known procedure of cardioversion and name it neuroversion e in other words, a possible normalization of brain activity and behavior triggered by a unique session of electrical stimulation. However, we acknowledge that further research, including randomized clinical trials, are needed to study this reported event.