1 BACKGROUND

First used over 80 years ago, electroconvulsive therapy (ECT) is the oldest of the currently used biological treatments in psychiatry. ECT is indicated for severe depression, mania, treatment‐resistant schizophrenia psychosis, catatonia, and comorbid depression in dementia. ECT delivers a unilateral or bilateral electrical stimulus to the brain of an anesthetized patient to induce a generalized seizure. Response and remission rates of ECT in depression are high (73%–90% and 67%–73%, respectively).¹ In bipolar disorder (BD) the effectiveness of ECT has been shown for manic, depressive, and mixed episodes. For treatment‐resistant bipolar depression, ECT is the treatment option with the most supporting evidence.² Nevertheless, in most guidelines for BD, ECT is advised only as a last‐resort option and in life‐threatening cases. This is possibly due to the stigma of ECT and concern for complications such as a switch to mania and neurocognitive side effects.

To date, data on safety and efficacy of ECT in older age bipolar disorder (OABD) are lacking, given that prior research has focused on mixed‐age cohorts. OABD is a specific group with special needs due to somatic and psychiatric comorbidity, cognitive vulnerability, as well as age‐related brain changes, life issues, and psychosocial functioning. The presence of somatic comorbidity limits pharmacotherapeutic options due to drug interactions and altered drug metabolism.³ Therefore, ECT may become a viable option for OABD earlier than in adult BD.

In current guidelines ECT is mostly advised as second‐ or third‐line therapy for adults with BD, but these are not further specified for OABD, given the lack of evidence from large clinical trials of OABD patients treated with ECT. Expert consensus suggests, however, that ECT is a safe and effective treatment in OABD.³

As an example of ECT effectiveness in OABD despite risk factors for neurocognitive side effects, we present in the current case report a patient with vascular hyperintensities in the brain and a previous history of ECT‐related cognitive impairment, who recovered with ECT.

中文翻译：

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ECT 是治疗易受认知副作用影响的双相情感障碍老年人抑郁症的可行选择吗？

1 背景

电休克疗法 (ECT) 于 80 多年前首次使用，是目前精神病学中使用的最古老的生物疗法。ECT 适用于重度抑郁症、躁狂症、难治性精神分裂症精神病、紧张症和痴呆合并抑郁症。ECT 向麻醉患者的大脑提供单侧或双侧电刺激，以诱发全身性癫痫发作。ECT 在抑郁症中的缓解率和缓解率很高（分别为 73%–90% 和 67%–73%）。¹在双相情感障碍 (BD) 中，ECT 对躁狂、抑郁和混合发作的有效性已得到证实。对于难治性双相抑郁症，ECT 是最有证据支持的治疗选择。²然而，在大多数 BD 指南中，仅建议将 ECT 作为最后的选择，并在危及生命的情况下使用。这可能是由于 ECT 的耻辱感以及对并发症的担忧，例如转向躁狂症和神经认知副作用。

迄今为止，鉴于先前的研究主要集中在混合年龄组，因此缺乏关于 ECT 在老年双相情感障碍 (OABD) 中的安全性和有效性的数据。OABD 是由于躯体和精神疾病、认知脆弱性以及与年龄相关的大脑变化、生活问题和心理社会功能而具有特殊需求的特定群体。由于药物相互作用和药物代谢改变，躯体合并症的存在限制了药物治疗的选择。³因此，ECT 可能比成人 BD 更早成为 OABD 的可行选择。

在目前的指南中，ECT 主要被建议作为成人 BD 的二线或三线治疗，但由于缺乏对接受 ECT 治疗的 OABD 患者的大型临床试验的证据，因此没有对 OABD 进一步指定这些治疗。然而，专家共识表明，ECT 是一种安全有效的 OABD 治疗方法。³

尽管存在神经认知副作用的危险因素，但作为 ECT 在 OABD 中的有效性的一个例子，我们在当前病例中报告了一名患有脑血管高信号和既往 ECT 相关认知障碍病史的患者，该患者通过 ECT 康复。