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Problems in Maintenance ECT in Bipolar Disorder: Replacement by Lithium and Anticonvulsants.

The authors describe three elderly patients whose electroconvulsive therapy (ECT) was characterized by protracted and unsatisfactory courses and frequent relapse. Sustained improvement resulted from the discontinuation of maintenance ECT and continuation of pharmacotherapy with combinations of lithium and carbamazepine or valproic acid. The patients are compared to a more typical patient with bipolar disorder who was successfully treated with long-term maintenance ECT. Difficulties in identifying and treating patients with atypical bipolar disorder are discussed.