Q:  Can ECT Cause Mania?

Dear Dr.Phelps,

Thank you so much for your very informative website. Much appreciated.

A quick question. Last Sept/Oct I was severely depressed, and suffering from delusions. Medications weren't helping and suicide was a real risk so my psychiatrist suggested ECT. I had 6 ECT treatments and totally recovered. I had been feeling quite a bit better after the 3rd one. My parents had previously booked a holiday away to the Canary Islands and because I was feeling fine I was keen to go.  My Dr was a bit cautious but agreed to letting me go.

Halfway during the week, 1 week after the last ECT I started becoming manic, and my mood contiued to escalate. I saw a dr out there who prescribed diazepam to help me get home on the plane. My mood didn't totally settle down for another 8 weeks.

Does ECT cause mania??  Or is it possible this was just the natural cycle of my mood as I do tend to become depressed and then cycle into mania. Maybe it was the increase in sunlight??? It wasn't the time zone difference as Ireland is on the same time as the Canary Islands. I would love to know because I found ECT to be so beneficial for my depression but if I thought it would cause mania I wouldn't have it again. I have searched for an answer to this on the internet and have yet to find one. I have discovered that it treats mania which confuses me even more!!

Thank you for your time
J


Dear J' -- 
Thanks for including that last line.  You're right, it treats mania, so that even if it had been responsible for inducing this episode (possible; ECT is known to be able to do this), I wouldn't think that was a reason not to use it again if necessary.  As you've surely concluded yourself, taking some measures next time, if there is a next time, to make sure that a recovering depression doesn't go right on into mania, would obviously be wise -- e.g. some mood stabilizer either through the ECT or at least starting up right after any clear shift upward in mood.

But you've also wisely included other possible factors.  You've learned that cross-time-zone travel is a known stimulus and ruled that out.  But I have one very stable patient who had a clear manic episode going to Mexico from Oregon, only a slight eastward shift.  So I think the "light" factor is a possibility as well.  You'd have to look back, as you've likely done, at just how much sleep you might have lost during the travel -- perhaps because of responding to earlier sunrise, or perhaps more simply just during the travel itself. 

Dr. Phelps

Published October, 2004