MAYO CLINIC – BIPOLAR DISORDER
NATIONAL INSTITUTE OF MENTAL HEALTH
My doctor thinks I should have ECT. I thought that was no longer used. What is it and what does it do?
There are many myths surrounding the use of electroconvulsive therapy (ECT). ECT is a procedure that induces a seizure in the brain through an application of electric current through the scalp. ECT is not a first line treatment (and is typically offered only after several failed medication trials or repeated hospitalizations), but it is a very effective treatment. It is very safe and is not painful. The patient is given anesthesia and a muscle relaxant for the procedure. For some patients, ECT is safer than medications, particularly for those with serious medical conditions for whom medication can be contraindicated, and for pregnant woman, who may not want to expose the fetus to certain medications (e.g., lithium). ECT is growing in use in elderly depressed patients because of higher rates of concurrent medical illness and risks of toxicity from medication.
Psychotic depressions are often refractory to medication, and thus ECT may be considered early in the treatment to avoid a prolonged course of medication trials. ECT is an effective treatment for acute mania when it is unsafe to utilize medication.
The risk of serious complication from ECT is 1/1000. Cardiac complications are the most common adverse effects, which is why a pre-ECT evaluation includes evaluation of the cardiac system. Most potential cardiovascular complications can be avoided with the use of appropriate medications. Confusion and/or memory loss is also common. Confusion is usually transient.
Memory deficits may be for events preceding or following the procedure. Memory deficits usually resolve over weeks to months after, although occasionally there are more persistent memory difficulties.
Although ECT provides rapid improvement in symptoms of depression and mania, there is a high rate of relapse-up to 50% within six months, so continuation/ maintenance ECT or medication is recommended following the treatment course. Continuation ECT is usually provided only if continuation medication has not successfully prevented relapse or recurrence of symptoms in the past.
ECT is usually done in a hospital setting as an inpatient (outpatient ECT may be provided for maintenance ECT). Medications are typically tapered off and discontinued prior to the treatment, and this process may need to occur in a hospital setting because of the risk for worsening depression and/or suicidality. ECT providers have received specialized training and certification.
While protocols may vary from state to state, usually more than one physician needs to evaluate the patient and determine that ECT is clinically appropriate. Unfortunately, due to a negative portrayal of ECT by the media over the years, even with the safety features in place, this very effective procedure is highly stigmatized and even illegal in some jurisdictions.
Are there any natural remedies for bipolar disorder?
“Natural” or alternative treatments describe any treatment that has not been scientifically documented or identified as safe or effective for a certain medical condition.
Examples of alternative treatments are acupuncture, yoga, herbal remedies, aromatherapy, biofeedback, and many others. In considering an alternative treatment, as with any scientifically documented treatment, you should consider the risks versus the benefits of such a treatment. If a particular procedure has no specific, direct risks associated with it, an important risk is potentially delayed treatment of the condition in question. For a mild depression, this risk may not be too great, but for a more severe depression with suicidal thoughts and certainly for an acute manic episode, it could be a fatal risk. Other risks include loss of money on an ineffective treatment, use of a treatment that is not standardized nor required to conform to specific regulations, and frustration when hopes of a unique treatment are not realized.
A number of dietary supplements have been touted to have effectiveness for depression, bipolar disorder, or mood lability in general, including St. John’s wort, SAM-E, omega-3 fatty acids, folic acids and other B vitamins, magnesium, phenylalanine, and taurine. Although there is some promising, albeit early, evidence for efficacy or utility of some of these interventions, the evidence is too limited in scope to consider such treatments safe and/or effective.
Herbal remedies are a popular “natural” choice for treatment of many other conditions. A common assumption about these “natural” treatment choices is that they are safe because they are natural. While herbs are found in nature, as with manmade chemicals, herbs have a specific chemical structure that also alters the body chemistry. As such, there can be significant side effects from such compounds as well.
Some of these side effects can be life threatening. For example, there have been many cases of liver failure from use of kava supplements around the world. In many cases, the problem per se is not that there are side effects; it is that the herbal treatments are not regulated as to either their safety or efficacy.
If a specific treatment is known to be effective, there may be certain risks one is willing to take for relief.
But without known efficacy it is not possible to make an informed decision as to the risks from exposure. Lack of regulation also means supplements available in the store are not rigorously tested for purity or quantity of the active compound in question.
Individuals who sell these treatments may pose as experts but have not necessarily obtained any specialized training or certification. Keep these issues in mind if you choose to undertake an alternative treatment so that you can make fully informed decisions about treatment
Will diet or exercise help with my mood?
Bipolar disorder is not caused by problems with diet, although some believe that a balanced diet would leave one less predisposed to difficulties handling stress and thus possibly any mood conditions that result from that stress. Sleep, on the other hand, has a stronger association with bipolar disorder. During a manic episode, a person has a decreased need for sleep. Although poor sleep will not cause bipolar disorder, lack of sleep can precipitate a manic episode in a bipolar individual.
Problems with sleep can predispose someone to depressive symptoms when chronically under-rested as well. Persons who sleep less than six hours per night have reduced concentration and irritability. In the management of bipolar disorder, development of good sleep hygiene is an important component of treatment for these reasons. Recent research has focused on the effects of exercise on mood and anxiety. Although the medical benefits of exercise are well known, the psychological benefits are less understood. Adults who exercise regularly report lower rates of depression and anxiety than the general population. Studies of the effect of exercise on depression have demonstrated positive results. Many theories exist as to how exercise improves mental health. Exercise causes changes in levels of serotonin, norepinephrine, and dopamine and causes the release of endorphins (which masks pain). It may reduce muscle tension, and adrenaline is released, which counteracts effects of stress. Psychologically too, exercise improves self-esteem, provides structure and routine, increases social contacts, and distracts from daily stress. Although the degree of impact that exercise has on mood disorders needs more research, there are many good reasons for including regular exercise as part of a treatment plan for bipolar disorder.
Term:
Alternative treatment – a treatment for a medical condition that has not undergone scientific studies to demonstrate its efficacy.
