Electroconvulsive Therapy (ECT) might be a Lifesaving Treatment Option for Bipolar Disorder.

March 3, 2025

Written by Joao L. de Quevedo, MD, PhD

Introduction

Electroconvulsive therapy (ECT) has been a subject of both fascination and controversy for decades. Often misunderstood due to its portrayal in popular media, ECT remains one of the most effective treatments for severe mental illnesses, including bipolar disorder. For individuals who struggle with treatment-resistant bipolar disorder, severe depressive episodes, or debilitating mania, ECT can be a powerful intervention that provides relief when other treatments have failed.

What Is Electroconvulsive Therapy?

ECT is a medical procedure in which controlled electrical currents are passed through the brain to induce a brief seizure. This process is performed under general anesthesia and using muscle relaxants to ensure patient comfort and safety. The exact mechanism by which ECT alleviates symptoms of bipolar disorder is not fully understood. Still, it is believed to enhance neuroplasticity, regulate neurotransmitter imbalances, and reset abnormal brain activity associated with mood disorders.

How ECT Helps in Bipolar Disorder

Extreme mood fluctuations, including depressive episodes and manic or hypomanic states characterize bipolar disorder. Traditional treatments, such as mood stabilizers, antipsychotics, and psychotherapy, are effective for many but not all patients. ECT is particularly beneficial in cases where:

  • Medications have failed to provide relief or have caused intolerable side effects.
  • Severe depression has led to suicidal thoughts or psychotic symptoms.
  • Mania is dangerously unmanageable and requires immediate intervention.
  • Rapid cycling (frequent mood shifts) prevents stability with conventional treatments.
  • Pregnant individuals require a treatment option that minimizes harm to the fetus (ECT is safer than many psychotropic medications in pregnancy).

What to Expect During an ECT Session

ECT is typically administered in a hospital setting, and a typical course involves multiple sessions, usually two to three times per week for several weeks. The procedure follows these steps:

  1. Preparation – The patient receives a medical evaluation, and informed consent is obtained.
  2. Anesthesia & Muscle Relaxant – Short-acting anesthesia and a muscle relaxant are administered to prevent discomfort and reduce movement during the seizure.
  3. Electrode Placement – Electrodes are placed on the scalp, either on one side (unilateral) or both sides (bilateral) of the head.
  4. Electric Stimulation – A small, carefully measured electrical current is applied to induce a seizure lasting about 30-60 seconds.
  5. Recovery – The patient is monitored in a recovery area until the anesthesia wears off, typically within 30-60 minutes.

Effectiveness and Benefits

Numerous studies have confirmed that ECT is highly effective in treating bipolar disorder, particularly severe depression. Studies suggest that up to 80% of patients with severe mood disorders show significant improvement after ECT. The benefits include:

  • Rapid symptom relief, often within days or weeks.
  • Higher success rates compared to medications in treatment-resistant cases.
  • Potential reduction in suicidal ideation in patients with severe depression.
  • Improvement in cognitive function over time despite initial memory concerns.

 

Risks and Side Effects

As with any medical procedure, ECT has potential side effects, but modern advancements have made it significantly safer than in the past. Common side effects include:

  • Short-term memory loss, particularly around the time of treatment. This usually improves within weeks or months.
  • Confusion or disorientation is more common in older adults and typically resolves within hours.
  • Headache or muscle soreness, often mild and treatable with over-the-counter medications.
  • Possible long-term memory issues, though rare and less frequent with unilateral ECT.

Addressing the Stigma

One of the most significant barriers to ECT is stigma. Many people associate it with outdated and inhumane movie portrayals or historical misuse. However, modern ECT is a safe, controlled, scientifically validated treatment that trained professionals administer. Education and advocacy efforts are essential to combat misconceptions and help individuals access life-changing treatment without fear or shame.

Conclusion

ECT is a vital treatment option for individuals with severe bipolar disorder who do not respond to conventional therapies. Despite concerns over side effects, its rapid effectiveness in alleviating severe depressive and manic symptoms makes it a crucial intervention. If you or a loved one is struggling with bipolar disorder and traditional treatments are not working, consulting a mental health professional about ECT could be the next step toward recovery.

References

  1. American Psychiatric Association. (2018). The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging (2nd ed.).
  2. Kellner, C. H., et al. (2012). “Continuation Electroconvulsive Therapy vs Pharmacotherapy for Relapse Prevention in Major Depression: A Multisite Study.” JAMA Psychiatry, 69(2), 124-132.
  3. Sienaert, P. (2011). “What We Have Learned About Electroconvulsive Therapy and Its Relevance for the Practicing Psychiatrist.” The Canadian Journal of Psychiatry, 56(1), 5-12.
  4. Perugi, G., et al. (2017). “Electroconvulsive Therapy (ECT) in Bipolar Disorder: A Review of Literature.” Current Neuropharmacology, 15(3), 346-358.
  5. Fink, M. (2009). “Efficacy and Safety of Electroconvulsive Therapy in Depressive Disorders: A Systematic Review and Meta-Analysis.” Acta Psychiatrica Scandinavica, 119(4), 236-248.

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