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Electroconvulsive therapy is a psychiatric treatment that is used to treat severe depression, catatonia and mania in patients through the use of electronically induced seizures. The patient is anaesthetized during the entire treatment process. The treatment is given to patients who do not respond to antidepressants or mood stabilizing medications. Electroconvulsive therapy is administered over a period of two weeks in a series of treatments; usually six to twelve.
Through-out the entire procedure, the patient is closely monitored. A rubber block is put in the mouth of the patient to prevent them from biting their tongue. Once the patient is unconscious, an electrical current is passed through the brain causing a grand-mal seizure that lasts up to twenty seconds. According to the American Psychiatric Association (1), the patient regains consciousness after half an hour.
Experts cannot pin-point how ECT works but the procedure is believed to relieve symptoms of depression, mania and catatonia. It causes changes in the chemical balances of the brain thus relieving some of the symptoms of mental disorder. The treatment varies in three ways: the positioning of the electrodes, the frequency of the treatments and the electrical waveform. However the effects of ECT do not last a long time and the patient has to go back for further treatments.
Using ECT in Bipolar Patients
Bipolar disorder is a psychiatric mood disorder where the patient experiences extreme mood swings. The illness is known to cause changes in lifestyle and health. Bipolar patients experience highs and lows in their moods otherwise known as depression and mania.
Depression is whereby the patient feels helpless, sad, despairing and worthless while mania is where the patient feels creative, has feelings of grandeur and is hyperactive. According to Malhi (3), sometimes, both the feelings of depression and mania can appear at the same time causing the patient to go into a “mixed state.”
Treatment of bipolar disorder varies among individuals. Some individuals may not respond to drugs used to treat bipolar. As mentioned earlier, ECT is used to treat cases where the patient fails to respond effectively to prescribed drugs. When other forms for managing the disorder aren’t effective, the psychiatrist is recommended to start using ECT in order to be able to manage the disease effectively.
Psychiatrists select bipolar patients for ECT on the following basis: the patients have acute psychosis, have severe mania such that they place their own and others’ well-being in danger, are pregnant and cannot or do not want to take medication, are at immediate risk of death by suicide, and their physical condition rules out the use of antidepressants.
Effectiveness of Using ECT as a Treatment for Bipolar
ECT has been used to treat the mania, depressive and mixed states effectively. The treatment has very little evidence to show that it is effective in treating of elderly patients suffering from bipolar. There are documented cases where they fail to respond to ECT treatment.
A study was conducted to establish the effectiveness of ECT as a form of treatment for bipolar disorders. Three studies were used to assess the outcomes of treating acute mania with ECT. 308 patients were chosen to take part in the randomized controlled study.
The patients were divided into two categories where some of the patients received ECT followed by lithium maintenance treatment. According to the group of researchers (2), the other patients received lithium as both acute and maintenance treatment. Those who received ECT followed by lithium maintenance showed significant improvements within a period of eight weeks. In another study, thirty manic patients were treated with chlorpromazine but were randomly grouped.
One group was given six ECT sessions while the other group received sham ECT sessions. Conditions of the patients that received the sham ECT sessions worsened as compared to those who received the actual ECT (2).
The treatment has also been effectively used to treat bipolar depression. According to a UK ECT review group in 2003, it was concluded that ECT was a more effective treatment for treating depressive disorders in bipolar than drug therapy (2).
Moreover, bilateral ECT was more effective than unilateral ECT as was high doses as compared to low doses. In the review of the trials, some of the reviews included depressed patients who were diagnosed with bipolar and unipolar disorder. Even though the studies of ECT in treating bipolar disorder were old, they still exhibited its effectiveness. Most of the studies done to investigate the effectiveness of ECT showed that the procedure was equal or superior to the use of antidepressant drugs.
Treatment for mixed state has not been thoroughly investigated and there are no prospective, randomized or controlled studies on the use of ECT as a controlled treatment. Even though it is believed that ECT may be effective in treating the mixed state, there lacks conclusive evidence to support this (3).
Disadvantages of ECT in Treating Bipolar
When treating a patient with bipolar depression, there exists a risk of the patient developing hypomania. However, the risk seems to be greater if the patient is treated using antidepressants. If ECT is used alone, there are chances that there will be a high relapse rate. The psychiatrist may also lack information in the kind of prophylactic medication to give to ECT patients.
The treatment is also associated with memory loss. However memory can be minimized by using brief pulse rather than sine wave ECT. The electrodes will be unilaterally placed by using the least number of treatments possible and by titrating the electrical current wave to according to the patient’s seizure threshold.
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There have been a number of incidences where the use of lithium during the ECT treatment has been known to cause neurotoxicity. Recent reviews show that there have been no links between neurotoxicity and the use of lithium in ECT treatments. Nevertheless, cases of neurotoxicity do exist.
Patients often complain about confusion, headaches, nausea, muscle soreness and heart disturbances. There exist some long term effects of memory loss especially among older patients. Some people complain that their memories have been completely erased even though memory is expected to return after the course of ECT treatment is over.
Other patients have complained about undergoing a personality change once they have gone through the therapy. They claim that the skills they possessed and talents are lost and cannot be recovered due to memory loss.
Another problem associated with ECT treatment is the stigma associated with it. This is based on early treatments which were considered to be barbaric and inhumane.
The patients were usually chained and high doses of electric currents were administered. The patients were usually left un-monitored and at the end of the treatment had broken bones or other physical injuries (2).
Some of these treatments even resulted in death. The patients were administered with the treatment against their own will. In addition, the treatment was done without any form of anesthesia.
However, through many adjustments, the treatment has today been made safer and the currents used are controlled and the patient is closely monitored to prevent serious injuries or adverse side effects. The stigma of the procedure being terrifying and inhuman still exists, though. Furthermore, the patient is given the option of choosing whether they prefer ECT as a form of treatment or not.
In conclusion, ECT treatment seems to be the most effective form of treatment for patients who do not respond to treatment through drugs. ECT requires continuous treatment so as to ensure the disease is properly managed. The treatment is highly recommended due to its rapid onset action. This makes it a good form of treatment for severe illness with suicidal risk.
- American Psychiatric Association. Practice guideline for the treatment of patients with bipolar disorder. [place unknown: publisher unknown]; 2010 [cited 2020 Feb 7].
- Le Masurier M, Herrmann LL, Coulson LK, Ebmeier KP. Physical treatments in bipolar disorder. In: Young AH, Ferrier IN, Michalak, EE, editors. Practical management of bipolar disorder. New York, NY: Cambridge University Press; 2010. p. 62-72.
- Malhi GS. Diagnosis of bipolar disorder: who is in a mixed state? The Lancet. 2013;381(9878),1599-1600.