Hematological and Inflammatory Marker Changes Following Electroconvulsive Therapy in Bipolar Mania: A Quasi-Experimental Study.

Abstract

Objective: Neuroinflammation, reflected in hematological and inflammatory biomarkers, plays a role in bipolar disorder. Electroconvulsive therapy (ECT) is effective for treatment-resistant bipolar disorder, but its impact on these biomarkers remains unclear. This study investigated changes in hematological and inflammatory markers before and after ECT in bipolar mania and their association with treatment response.

Methods: A quasi-experimental study was conducted on 30 inpatients with bipolar mania undergoing ECT. Blood samples were collected before anesthesia induction and 2 hours postseizure at the initial and final sessions. Hematological indices, including mean cell hemoglobin (MCH), red blood cell count (RBC), white blood cell count (WBC), mean corpuscular volume (MCV), and platelet count (Plt), along with inflammatory markers such as C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII), were analyzed. A ≥25% reduction in Young Mania Rating Scale (YMRS) scores defined clinical response.

Results: CRP significantly increased after both the first ( P =0.01) and final ( P <0.001) ECT sessions. NLR ( P =0.001) and PLR ( P =0.002) showed a transient rise after the first session but not at the final session. Other hematological indices remained largely unchanged. No significant correlation was found between inflammatory marker changes and treatment response, though baseline CRP correlated with baseline YMRS scores ( P =0.013).

Conclusions: ECT induces a transient inflammatory response, but these biomarker changes did not predict clinical improvement, suggesting systemic inflammation may not be central to ECT efficacy in bipolar mania. Further research is needed.