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Bipolar Disorder Treatment - Hospitalization and Electroconvulsive Therapy

Rashmi Nemade, Ph.D. & Mark Dombeck, Ph.D.

Medications are the primary means of treatment for bipolar disorder, but they are by no means the only useful bipolar disorder treatments that exist. A range of other medical and non-medical treatments complement bipolar medications. Figuring most prominently into this set of complementary treatments are hospitalization, electroconvulsive therapy, and various forms of psychotherapy.

Bipolar Disorder Treatment - Hospitalization

front building doorsAlthough most bipolar patients do not require extended inpatient psychiatric hospitalizations, short-term hospitalizations can be necessary during real or potential illness crises (e.g., severe mood episodes, suicidal attempts, untreated bipolar symptoms, bipolar medication adjustments, etc.). More severe cases of bipolar disorder (e.g., Bipolar I Disorder) are more likely to require more frequent intermittent hospitalizations, due to their more severe symptom profiles.

Hospitalization is among the more expensive bipolar treatment options available, and it is correspondingly offered sparingly and generally only when no other treatment options will prove sufficient to insure patient safety. During their time in the hospital, patients are diagnosed (if their diagnosis is not already clear), and started on bipolar medication. Alternative psychiatric treatments such as electroconvulsive therapy may also be administered if they are indicated, and patients agree to receive them. Patients are typically integrated into the hospital ward's' therapeutic milieu which may consist of regular patient groups, scheduled eating, sleeping and recreational periods, and occasional interviews with physicians and nurses. As soon as is practical (meaning, as soon as symptoms start to turn around, and there is no imminent risk of suicide), patients are discharged back to their homes and regularly scheduled supportive care. To the extent that outside supports are not adequate (e.g., there is no treating psychiatrist, or no psychotherapist, or housing is not adequate, etc.) the hospital may aid with coordination of care (so that a psychiatrist or psychotherapist will be found to take the case, or a shelter may be found).

Bipolar Disorder Treatment - Electroconvulsive Therapy (ECT)

One of the more successful non-medical therapies available to bipolar patients is ECT. Electroconvulsive therapy involves the passage of an electric current through the brain to artificially create a seizure. It is primarily reserved for treatment-resistant forms of acute mania and depression which have proven themselves impervious to alternative bipolar medication treatment.

The mention of ECT conjures up a veritable torture session in most people's minds (certainly so for those who have seen psychiatry-themed movies such as "One Flew Over The Cuckoo's Nest"), but such images are not at all realistic depictions of modern ECT. Though an electrical current is indeed passed through the brain and body, the waveform of this current is carefully modulated for safety and maximal therapeutic benefit. There is no shaking or biting of tongues associated with the procedure because patients are given muscle relaxants prior to ECT sessions to prevent such damage. Most importantly, results from ECT treatment are often fairly remarkable, in that previously unremitting mood episodes are quickly "reset" and more normal mood emerges.

The procedure has one rather large and glaring negative side effect in that it causes temporary short-term memory loss. Memories of actually experiencing the treatment itself and of the time period shortly before treatments occur are blurred or erased. Since ECT treatment is typically reserved for patients who simply do not respond to other available bipolar disorder treatments, and since untreated depressive and manic states are themselves dangerous (considering the risk of suicide or other impulsive self-damaging behavior), this memory loss is often considered a reasonable price to pay.

Despite its bad reputation, ECT can be literally lifesaving in cases of suicidal bipolar depression. It is reasonably safe and generally has a fast and pronounced positive bipolar treatment effect. In addition, when used to treat unremitting depressive episodes, it does not increase cycling periods or precipitate a manic episode as antidepressants might. Furthermore, because it has no systemic effects (as do all bipolar medications), ECT may, in fact, be the safest treatment for pregnant women or nursing mothers suffering from bipolar disorder.