Most people who experience a severe episode of depression in bipolar disorder respond to treatment with some combination of the medications described above. A few do not. For those few, electroconvulsive therapy (ECT) may bring welcome relief from the symptoms. The improvement can be dramatic. For patients who are seriously suicidal, it may be life-saving. ECT is also effective in treating mania, but it is rarely needed for this purpose as medications are usually rapidly effective in this phase of the illness.
ECT is the electrical induction of seizures in anesthetized patients. An ECT series may comprise twelve or more treatments conducted at a rate of about three a week. Some people undergoing the procedure may experience memory loss or confusion, but these side effects are almost always transient. The memory loss is most evident for events that occurred during the period of treatment. Patients with bipolar disorder undergoing this procedure must first be withdrawn from anticonvulsant medications, as these are likely to prevent the occurrence of the required seizure. It may also be necessary to stop taking lithium during ECT treatment in order to minimize the possibility of developing confusion.
Sometimes ECT is only effective in producing a remission of symptoms for a few weeks or months. Recurrence of symptoms is much less likely if the patient is taking medications. Medications which were ineffective in getting the person out of a severe depression may prove to be effective, after ECT, in preventing a recurrence. For those few people where medications do not prevent relapse, maintenance ECT – perhaps a treatment every 4 to 6 weeks – is very likely to prevent recurrence.
ECT has gotten a bad name, largely due to the dramatic, negative images in movies such as The Snake Pit and One Flew Over the Cuckoo’s Nest, showing how it was used, decades ago, without anesthesia and without patient consent. In fact, it is a safe and effective treatment which is only used selectively for people who have not responded to treatment with medications.
Much more information about psychotherapy and other aspects of the treatment of bipolar disorder can be found in the comprehensive guide written by David Miklowitz, a professor of psychology at the University of California, Berkeley, The Bipolar Disorder Survival Guide: What You and Your Family Need to Know (Guilford Press, 2002).