Bipolar Disorder

Description

Alternative Names

Other Treatments

Commonly called shock treatment, electroconvulsive therapy (ECT) has received bad press since it was introduced in the 1930s. Over the years it has been refined, however, and may now even be safer than lithium. It may be particularly beneficial for the following patients:

• Patients who need immediate stabilization of their condition and who cannot wait for medications to be become effective.
• Most patients with mania. (It may be particularly important for elderly patients with severe mania.)
• Patients who suffer suicidal thoughts and guilt during the depressive phase.
• Patients who simply prefer ECT.
• Pregnant patients.
• Patients who cannot tolerate drug treatments.
• Patients with certain types of heart problems.
• Young patients.

In a review of studies, about 80% of ECT-treated patients experienced improvement, and for some, it is the only treatment that works.

The Procedure. Hospitalization is not necessary for the treatment. In general, ECT proceeds as follows:

• A muscle relaxant and short-acting anesthetic are administered.
• A small amount of electric current is sent to the brain, causing a generalized seizure that lasts for about 40 seconds.
• The response to ECT is usually very fast, and the patient often needs less medication afterward.

Side Effects. Side effects of ECT may include temporary confusion, memory lapses, headache, nausea, muscle soreness, and heart disturbances. Administration of the drug naloxone immediately before ECT may help reduce its effects on concentration and some (but not all) forms of memory impairment. Concerns about permanent memory loss appear to be unfounded. One study that used brain scans before and after ECT found no evidence of cell damage. In another small study of teenagers who had undergone ECT for severe mood disorders, only one of 10 reported memory impairment three and one half years after the treatment.

The Biologic Effects ECT on Bipolar Disorder. The precise mechanism by which ECT benefits bipolar disorder patients is not clear.

• Some research is focusing on changes that ECT exerts on the brains physiology. It may increase the permeability of the blood-brain barrier, produce an anti-seizure effect (similar to the effects of anti-seizure drugs used as mood stabilizers), and reduce blood flow in part of the brain correlated with improved mood.
• Another theory suggests that various hormonal changes that occur during ECT produce the primary benefits, with particular interest in changes in thyroid-related hormones.
• Yet another theory posits that the benefits of ECT stem from its effects on dopamine levels. This neurotransmitter probably plays an important role in bipolar disorder as well as other conditions for which ECT is sometimes recommended, including delusional depression.
• ECT appears to stimulate growth of neurons in the hippocampus (the area in the brain responsible for memory).

Experimental Procedures

Magnetic Therapy. Repeated transcranial magnetic stimulation (rTMS) is also being studied for depression and bipolar disorder. Unlike ECT, this procedure appears not to cause seizures, memory lapses, or impaired thinking. The only side effect reported is a mild headache. One study in patients with unipolar depression found that after one year relapse rates were significantly lower after rTMS than after ECT, although only a few small studies have been conducted using this procedure and it still needs refinement.

Acupuncture. The first study on acupuncture as an add-on therapy for bipolar disorder is currently underway in the US. Some studies have suggested that acupuncture may affect part of the nervous system that regulates the stress response, which might aid patients with bipolar disorder.