We have experienced a case of depression which switched to mania during the course of electroconvulsive therapy(ECT). The depressive symptoms responded well to ECT but by the third treatment in this course, the patient rapidly lapsed into manic state, showing typical psychomotor excitement, combativeness, and so on. There was no evidence of significant organic impairment. ECT was stopped and then combined trial of lithium and haloperidol was started. By this regimen, the patient’s manic symptoms were gradually subsided and eventually he was discharged 1 month later. The direct causal relationship between ECT and the ‘switch process’ has not yet been fully elucidated. However, clinicians should be alert for the fact that depressed patients recieving electroconvulsive treatment could develop manic states. Further research is needed to establish the strategies for management and prevention of this troublesome iatrogenic complication.
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