To stop or not to stop? Combined use of valproate and electroconvulsive treatment

Clinical decision regarding the combination of valproate and electroconvulsive treatment (ECT) has been contradictory. Concerns exist that anticonvulsants that are used a mood stabilizers may interfere with seizure during ECT. This report examines the clinical use of concurrent ECT and valproate in full dose and reduced dose for manic episode of bipolar disorder. Methods: We studied the records of 75 consecutive non-epileptic bipolar dis-order manic episode patients referred for ECT between the months of April 2010 and July 2013 in an psychiatric hospital. We compared mean stimulus intensity, mean seizure duration, number of ECTs administered and changes in Young Mania Scale scores between those who were on full dose valproate, 40% reduced dose valproate and those who were not on valproate or other mood stabilizers. Results: Valproate free group and 40% reduced valpro- ate dose group did not significantly differ in seizure duration but full dose valproate group had significantly shorter seizure duration than valproate free group. The full dose valproate group had significantly higher number of ECT sessions required. The treatment combination was well tolerated, with no serious adverse events observed in full dose or reduced dose valproate groups. All 75 patients had significantly reduced scores on Young Mania Scale. Discussion: Concurrent use of valproate with ECT in bipolar diorder manic episode seems safe, did not interfere with routine ECT practice, and allowed for transition to maintenance pharmacotherapy. Prospective studies are required to confirm these findings and also to compare cognitive adverse effects.