ECT and Bipolar Disorder

This article briefly describes electroconvulsive therapy (ECT), but

is not intended as an authoritative guide.  The author is not a

doctor and is certainly not your doctor, the person to whom you

should first turn.  The description is based on worthwhile internet

sources for which links are provided.


ECT has a frightening image.  Graphically depicted in movies such as

One Flew Over the Cuckoo's Nest , ECT is often portrayed as a cruel,

dehumanizing treatment from the stone age of psychiatry.


This image is inaccurate and insidious.  ECT is still used to treat

depression despite the improvement of drug therapies because it often

works for certain individuals where alternatives do not.  The

procedure is particularly useful for the severly depressed and

individuals who can not tolerate drug treatment because of illness or

age.  It can literally save lives among the suicidal.


Like its popular image, the very term electroconvulsive therapy is

misleading.  "Electro" refers to the electrical current used to

induce a seizure.  However, the electricity is not responsible for

the therpay's effectiveness, if anything it may cause or aggravate

the most common side effect of ECT, amnesia.  "Convulsive" describes

the physical convulsions of the body during a seizures, a rhythmic

motion of the skeletal muscles, which again have no relevance to

treating depression.


The relationship between seizures and depression was first observed

in the early 1900's, when it was noted that patients with both

epilepsy and depression experienced a remission of the depression

after a seizure.  The early efforts at artificially inducing seizures

to treat other patients were crude and led to a host of problems,

mostly related to uncontrolled convulsions which could break bones

and poor understanding of how the therapy worked.  Although ECT is

now far more refined, these images continue to haunt it and

stigmatize those who have had it.


In modern ECT, a muscle-relaxing drug is first administered which

reduces the physical convulsions to safe levels.  The patient is also

anesthetized, and so is not conscious.  The seizure is induced by a

small electrical current delivered through electrodes taped to the

patient's head.


ECT is a significant procedure with risks and potential side effects.


As for ECT in bipolar patients, the particular risk is that the

seizure can ignite a manic episode.  This can be effectively

controlled with fast-acting anti-mania drugs such as the old standby,



As with any medical treatment, the risks must be balanced against the

benefits.  In doing so, it is important to remember that ECT is often

a treatment for patients in great need or who haven't responded to

alternatives, and who may be suicidal.






Ah yes, I forgot a cite you may want to look at for ... completeness:


thank you Andrew!!





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