"˜How bad do I have to be to qualify for ECT?'

Medical Reviewer

Despite seven years of medication and doing what you're supposed to do, M.U. feels no relief from symptoms. M.U. says it affects every aspect of life but she also has concerns about changing meds because of previous bad effects. 'How bad do I have to be to qualify for electroconvulsive therapy?' M.U. say, 'I want to try to zap it out. Plain and simple.'

Electroconvulsive therapy (ECT) isn't considered a first-line treatment but it can be effective for severe bipolar episodes. When M.U. asks 'how bad do I have to be?' the answer it seems depends on where you live and your severity of symptoms (as perceived by your psychiatrist). One of the major concerns over the use of ECT is whether it causes damage to the structure and/or function of the brain. For this reason its use is subject to fairly stringent restrictions. However, one of the reasons that ECT is still available as a treatment is that it can be extremely effective.

When I say that ECT isn't thought of as a first-line treatment, I mean that it only tends to be considered when other treatments have not been effective. It may be considered if the person is perceived as high risk for suicide, where there are prominent psychotic features of depression, or where very severe depression is not responding to other forms of treatment.

If ECT is prescribed a typical course may be anywhere between 6 to 9 treatments around 2 or 3 times per week. Sedatives are first given, followed by muscle relaxants. When the patient is fully anesthetized an electrical current is passed into the brain. Evidence suggests that ECT delivered to both hemispheres of the brain (bilateral) is more effective than to one hemisphere (unilateral). However, high dose right unilateral appears as effective but without the side effects, such as memory loss, that frequently accompanies bilateral ECT.

So when M.U. says 'I want to zap it out. Plain and simple,' what are we to answer? I guess the first thing is to sympathize with her frustration and the need to have something done. As yet, there is no cure for bipolar disorder so more pragmatically perhaps, I have to point towards what is actually known about the effectiveness of ECT. It is well known that ECT can provide fairly speedy and effective relief, but it does have limitations. The main limitation is that it has a very high relapse rate. Numerous studies also point to loss of memory. Memory seems to improve during the months after treatment but amnesia for events immediately before ECT often remains. Around the time of treatment it is quite common for people to experience confusion and some memory loss.

Have you or someone you know had ECT for bipolar? What was the experience like? Would you recommend it to M.U? Do you have a view about ECT as a treatment? Share your thoughts with us.