When electroconvulsive therapy fails

Cognitive-behavioral therapy in treatment-resistant bipolar depression. A case report

Jiann Lin Loo, Farah Deena Binti Abdul Samad, Hatta Sidi, Maniam Thambu

Research output: Contribution to journalArticle

Abstract

Background: Electroconvulsive therapy (ECT) is one of the standard treatments for treatment-resistant bipolar depression (TRBD). However, there is limited literature on the role of cognitive-behavioral therapy (CBT) in patients with TRBD who fail to respond to ECT. Aim: To establish whether TRBD resistant to ECT may be successfully treated with CBT. Method: A case report of a patient with TRBD who achieved full functional recovery with CBT in combination with pharmacotherapy after failing to respond to ECT. Results: A 45 year-old male with diabetes mellitus, diabetic retinopathy and bipolar II disorder presented with a third recurrence of a depressive episode. In view of poor response to the combination pharmacotherapy, he was diagnosed with TRBD and prescribed a full course of ECT. Failing that, he was then given CBT in combination with pharmacotherapy and achieved full functional recovery. Discussion: To date there is a lack of consensus on either the diagnostic criteria of TRBD or evidence-based guidelines for the treatment of TRBD. Adjunctive modafinil, pramipexole, tranylcypromine and vagus nerve stimulation have been tried but the response rate is variable. Family-focused treatment, group psychoeducation and interpersonal and social rhythm therapy have been tried in bipolar depression but more research is still required for TRBD patients that failed to respond to ECT. In conclusion, combination of CBT and pharmacotherapy is worth a try for TRBD patients who do not respond to ECT.

Original languageEnglish
Pages (from-to)67-69
Number of pages3
JournalArchives of Psychiatry and Psychotherapy
Volume18
Issue number2
DOIs
Publication statusPublished - 1 Jun 2016

Fingerprint

Treatment-Resistant Depressive Disorder
Electroconvulsive Therapy
Cognitive Therapy
Bipolar Disorder
Drug Therapy
Tranylcypromine
Vagus Nerve Stimulation
Diabetic Retinopathy
Therapeutics
Consensus
Diabetes Mellitus

Keywords

  • Cognitive-behavioral therapy
  • Electroconvulsive therapy
  • Treatment-resistant bipolar depression

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology

Cite this

When electroconvulsive therapy fails : Cognitive-behavioral therapy in treatment-resistant bipolar depression. A case report. / Loo, Jiann Lin; Samad, Farah Deena Binti Abdul; Sidi, Hatta; Thambu, Maniam.

In: Archives of Psychiatry and Psychotherapy, Vol. 18, No. 2, 01.06.2016, p. 67-69.

Research output: Contribution to journalArticle

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