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Electroconvulsive Therapy for Bipolar Disorder

Electroconvulsive therapy (ECT) is a psychiatric treatment that uses electricity to induce seizures in a patient. Sometimes, the procedure is simply called electroshock. ECT is most often used in severely depressed patients who have not responded to more traditional treatment methods.

ECT was first introduced in the 1930s. At that time, the procedure was very controversial. Over the years, however, the treatment has progressed. It is now considered a safe treatment method for people suffering from severe bipolar disorder. Approximately 1 million people worldwide undergo ECT each year.

Bipolar Disorder Overview

While most people experience mild mood swings from time to time, people with from bipolar disorder suffer from severe, often dibilitating shifts in mood. A person with bipolar can be extremely happy (manic) one day, only to be devastatingly depressed the next.

A person suffering from bipolar disoder may also experience sudden changes in energy levels and changes in the ability to function normally. Luckily, there are several treatments available to help people with bipolar disorder.

ECT: Who Benefits?

Electroconvulsive therapy has shown to be beneficial for:

elderly patients with severe mania
people who cannot take medication
people whose condition needs to be stabilized immediately (i.e., people who cannot wait for other methods of treatment to work)
people with certain heart conditions
suicidal patients.

To determine if a patient is a good candidate for ECT, a doctor will consider a person's medical history, treatment history and more.

How Does ECT Work?

While researchers are still working to determine how ECT helps patients, they believe it may be due to the following:

ECT might cause changes to the brain's physiology. For example, ECT might reduce blood flow to certain parts of the brain.
ECT might cause hormonal changes.
ECT might stimulate the growth of neurons in the hippocampus, the area of the brain responsible for memory.

The ECT Procedure

Prior to an ECT, patients will need to stop taking any medications that might interfere with the treatment. They will also need to undergo a physical exam, which will include an oral exam. Any problems with the patient's teeth will need to be addressed, as weak teeth could be damaged by the clenching and unclenching of the jaw during the ECT.

The patient will be asked to avoid food and drink for a specific period of time prior to the ECT. This is done to avoid complications with the anesthesia.

ECT is generally performed on an outpatient basis. Following the procedure, hospitalization usually isn't required.

During the ECT:

The doctor will attach electrodes to monitor the patient's heart activity. Blood oxygen levels and brain activity will also be monitored during the procedure.
The patient is given a muscle relaxant and short-acting anesthesia.
A bite block is placed in the patient's mouth to reduce damage to the teeth and jaw.
The doctor sends a small amount of electricity to the brain, which causes a generalized seizure that lasts for approximately 40 seconds.
Once the patient's breathing has returned to normal, he will be observed for at least 30 minutes.

Side Effects and Risks of ECT

After the ECT, some patients will experience nausea and vomiting. Some patients will also feel agitated or will be mildly confused.

While modern ECT is considered to be a safe procedure, it does carry some risks, including:

headaches
irregular heart rates
muscle aches
risk of death due to complications with anesthesia
short-term memory loss that may last for a few weeks
soreness.

Resources

Schimelpfening, Nancy (2007). Electroconvulsive Therapy (ECT). Retrieved July 17, 2007, from the About.com Web site: http://depression.about.com/od/ect/a/ect.htm.

Spearing, Melissa (2002). Bipolar Disorder. Retrieved July 17, 2007, from the National Institute of Mental Health Web site: http://www.nimh.nih.gov/publicat/bipolar.cfm.

University of Maryland Medical Center (2006). Bipolar disorder. Retrieved July 17, 2007, from University of Maryland Medical Center: http://www.umm.edu/patiented/articles/
what_electroconvulsive_therapy_other_procedures_
bipolar_disorder_000066_8.htm.

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