While ECT has been suggested as a second-line treatment option for single disorder bipolar in very severe cases (e.g., treatment-resistant or acute mania, depression, suicidality) [1026, 1027], to date, few research studies have assessed the efficacy of ECT in treating co-occurring bipolar and AOD use disorders.
Of the research that has been conducted, one study conducted a retrospective analysis of Swedish medical records of people with bipolar and depression, both as single disorders and co-occurring with AOD use, who had previously received ECT [1044]. ECT was found to improve remission rates from baseline for people with single disorder bipolar, at a similar rate to people with unipolar depression (35% for bipolar vs. 45% for unipolar depression). However, people with co-occurring mood disorders and AOD use had lower remission rates compared to people without co-occurring AOD use (26% to 29% vs. 42% to 47% respectively) [1044].
In a second study conducted among 190 adolescents and young people aged 16 to 25 with depressive, psychotic and bipolar disorders, a course of five ECT treatments was found to reduce AOD use outcomes, such as cravings and problematic behaviour associated with substance use, relative to baseline [1045]. Following these treatments, people also demonstrated reductions in the frequency of depressive and psychotic symptoms, as well as self-harm ideation [1045]. However, it should be borne in mind that bipolar disorders made up only a very small subsample of this study (14%). While these studies may be promising, more conclusive evidence for the use of ECT among people with co-occurring bipolar and AOD use is needed.