Physical treatments in bipolar disorder
Le Masurier M., Herrmann LL., Coulson LK., Ebmeier KP.
© Cambridge University Press 2010. Although the mainstay of treatment in bipolar affective disorder is pharmacological, a tradition of physical treatments has continued to survive, often in the face of bad press. Side effects and the controversial image of electroconvulsive therapy (ECT) have spawned a multitude of alternative treatments in an attempt to emulate its superior efficacy in the treatment of depression. After an initial account of the use and efficacy of ECT in bipolar depression and mania, we will give a description and preliminary evaluation of some of these alternative techniques. Electroconvulsive therapy in bipolar disorder In 1776 the Viennese physician Leopold Auenbrugger described the use of camphor-induced seizures in the treatment of mania (Lesky, 1959). Electroconvulsive therapy was first employed in a manic patient in 1938, and by the 1950s ECT was widely used to treat a range of psychiatric disorders (Fink, 2001). It was superseded in the 1960s with the advent of psychotropic drugs, but experienced a later resurgence in treatment-resistant cases. Electroconvulsive therapy has been successfully used to treat the varying presentations of bipolar disorder (BD), including bipolar depression, mania, catatonia and mixed affective states. Electroconvulsive therapy in bipolar depression A systematic review and meta-analysis conducted by The UK ECT Review Group identified 73 randomised trials of ECT efficacy and safety in depressive illness (UK ECT Review Group, 2003). The authors concluded that ECT is an effective treatment for depressive disorders, and is probably more effective than drug therapy.