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Bipolar disorder

Description

An in-depth report on the causes, diagnosis, and treatment of bipolar disorder.

Alternative Names

Manic depression

Other Treatments

Electroconvulsive Therapy

Electroconvulsive therapy (ECT is a non-drug treatment for bipolar disease and other mental disorders, such as severe depression. It is commonly called shock therapy. ECT has received bad press since it was introduced in the 1930s. But, over the years it has been refined, and is now considered a very safe treatment.

Research suggests ECT may be particularly beneficial for:

• Patients who need immediate stabilization of their condition and who cannot wait for medications to work
• Most patients with mania -- especially elderly patients with severe mania
• Patients who suffer suicidal thoughts and guilt during the depressive phase
• 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. ECT is performed on an outpatient basis and does not require hospitalization. In general, the ECT procedure is performed as follows:

• A muscle relaxant and short-acting anesthetic are given to the patient.
• A small amount of electricity 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. Taking 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 1 in 10 reported memory impairment 3.5 years after treatment.

Biologic Effects of ECT on Bipolar Disorder. The precise way that ECT benefits patients with bipolar disorder is not clear. ECT may help by:

• Causing changes in the brain's physiology. For example, ECT may increase the permeability of the blood-brain barrier, produce an antiseizure effect (similar to the effects of antiseizure drugs used as mood stabilizers), and reduce blood flow in parts of the brain associated with improved mood.
• Causing various hormonal changes, particularly with thyroid-related hormones
• Balancing dopamine levels. This brain chemical plays an important role in bipolar disorder as well as other conditions for which ECT is sometimes recommended, including delusional depression.
• Stimulating growth of neurons in the hippocampus (the area in the brain responsible for memory)

Some studies are finding that maintenance electroconvulsive therapy (ECT) may be helpful for patients who do not respond to medications. In one study of patients with bipolar disorder, those who had intractable recurrent episodes received monthly ECT treatments for more than a year and a half. Without ECT, those patients spent an average of almost half a year in the hospital, suffering at least three episodes annually. After ECT, all the rapid cyclers achieved full or partial remission.

Experimental Procedures

Magnetic Therapy. Repeated transcranial magnetic stimulation (rTMS) is also being studied for unipolar and bipolar depression. Unlike ECT, this procedure does not appear to cause seizures, memory lapses, or impaired thinking. The only common side effect is a mild headache.

• Review Date: 12/26/2006
• Reviewed By: Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital

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