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Treatment-resistant bipolar depressions plague patients and clinicians. In a 6-week, multisite, publically funded, Norwegian study, researchers randomized 73 patients with treatment-resistant bipolar I or II disorder to electroconvulsive therapy (ECT; ≤18 treatments) or individualized, algorithm-based psychopharmacotherapy (men, 51%; bipolar I disorder, 40%; mean age, 48; mean illness duration, 30 years; mean lifetime depressive episodes, 20). Treatment resistance was defined as no response during lifetime to two trials of mood stabilizers shown effective for bipolar depression (lamotrigine, lithium, olanzapine, or quetiapine) and/or antidepressants.
Of 66 patients in the final intention-to-treat group, only 43 fully completed treatment. ECT…