Electroconvulsive therapy (ECT) can help stabilize mood shifts and relieve depressive or manic episodes associated with bipolar disorder.
Bipolar disorder is a complex mental health condition that involves significant shifts in mood and energy levels.
In many cases, bipolar disorder does not respond well to medications. This may lead to frequent relapses and ongoing challenges in managing the condition.
Mental health professionals generally recommend ECT when other options have not helped or when the condition is life threatening.
As evidence supporting ECT’s safety and effectiveness continues to grow, however, healthcare professionals may potentially recommend it as an earlier option for managing bipolar disorder.
Electroconvulsive therapy (ECT) involves the delivery of electrical currents to your brain, typically while you’re under anesthesia and muscle relaxants. The electrical currents stimulate controlled seizures, which can lead to changes in brain chemistry.
ECT is believed to affect neurotransmitters and stimulate neuroplasticity, potentially providing quick relief when other treatments have failed.
ECT can be used as a treatment for bipolar disorder, particularly when other treatments like medication and psychotherapy have not helped or when more immediate relief from severe symptoms is needed. ECT can help stabilize mood shifts and reduce depressive or manic episodes associated with bipolar disorder.
Mental health professionals will make the decision to use ECT for bipolar disorder on a case-by-case basis after careful evaluation.
ECT can be effective in treating severe episodes of bipolar disorder, including depression, mania, and catatonia. But keep in mind that your individual response may vary based on your:
- other health conditions
- prior medication use
The key findings showed that:
- ECT was highly effective, with an 80.2% response rate.
- People of a more advanced age experienced a better response to ECT.
- Other health conditions like obsessive-compulsive disorder (OCD) or personality disorders reduced ECT response.
- Previous treatment with lamotrigine led to lower ECT response.
- Of the participants, 68.8% had a positive response to ECT in 68.8%.
- The highest response rates (80.8%) occurred in individuals with catatonic features.
- ECT was more effective in people with shorter and less severe episodes of bipolar disorder.
The authors believe these findings challenge the idea that ECT should be considered only as a last-resort treatment for severe and drug-resistant bipolar disorder.
ECT is typically administered in a series of sessions, and a common course of treatment might involve
These sessions are usually scheduled a few times per week. The exact number of sessions may be adjusted based on your symptoms, severity, and treatment plan.
This includes bipolar disorder with:
- severe depression
- catatonic features (difficulty with movement, stupor, inability to speak, and rigidity)
- mixed states (a combination of depressive and manic symptoms occurring at the same time)
- mania (in specific cases, including severe and drug-resistant episodes of mania or life threatening physical exhaustion)
- rapid cycling course (considered as an alternative in drug-resistant episodes)
ECT is generally considered safe when administered by trained professionals in a controlled medical environment.
Although guidelines often recommend ECT as a last resort, in practice it’s sometimes considered earlier than medications for certain critical cases.
What are the long-term side effects of ECT?
Long-term side effects of ECT are generally rare. Yet some potential long-term concerns associated with ECT include:
- Memory issues: Memory concerns, particularly related to short-term memory and the ability to recall recent events, are the most commonly reported long-term side effects.
- Cognitive changes: Some individuals may experience cognitive changes, such as difficulty with concentration, attention, or cognitive processing speed. These changes are usually mild and temporary but can linger in a small percentage of cases.
- Dental and oral health: Rarely, ECT can lead to dental issues linked to mouthguards and muscle contractions during seizures. One study from 2020 found that out of all ECT treatment series performed, only
0.2%resulted in a dental fracture. This equals 2 dental fractures out of every 1,000 series of ECT treatments performed.
- Fractures: Bone fractures are an extremely rare complication of ECT: about
3.56 per 1 millionECT treatments. This rate is significantly lower than the risk associated with other medical procedures like colonoscopies or general anesthesia.
ECT can be an effective treatment option for individuals with severe and drug-resistant bipolar disorder. It has shown positive response rates in various phases of the disorder, including depression, mania, and catatonia.
Some researchers suggest that ECT should be considered as an earlier treatment option for bipolar disorder rather than later. However, as with any medical procedure, your and your healthcare team should carefully evaluate the benefits and risks of ECT to determine whether it’s appropriate for you.