Electroconvulsive Therapy for Treatment-Resistant Late-Onset Bipolar Disorder

This paper presents the case of a woman with a psychiatric history of major depressive disorder and generalized anxiety disorder, who experienced her first manic episode at age 50, likely triggered by occupational stress. She was diagnosed with bipolar I disorder and underwent multiple trials of antipsychotic and mood-stabilizing medications, including cariprazine, olanzapine, lumateperone, lithium, and valproate. Despite several pharmacological interventions, the patient continued to exhibit mood instability, frequent panic attacks, and functional decline. Following a course of 12 electroconvulsive therapy (ECT) sessions, she showed significant clinical improvement, including remission of manic symptoms, reduction in panic attacks, and regained occupational functioning.