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Bipolar Disorder Treatment - Hospitalization and Electroconvulsive Therapy

Rashmi Nemade, Ph.D. & Mark Dombeck, Ph.D., edited by Kathryn Patricelli, MA

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. These often include hospitalization, electroconvulsive therapy, and various forms of psychotherapy.

Bipolar Disorder Treatment - Hospitalization

front building doors Most patients with bipolar disorder do not require extended inpatient psychiatric hospitalizations. However, short-term hospitalizations can be necessary for situations such as:

  • severe mood episodes
  • suicidal attempts
  • untreated bipolar symptoms
  • bipolar medication adjustments

More severe cases of bipolar disorder are more likely to require more frequent intermittent hospitalizations.

Hospitalization is among the more expensive bipolar treatment options available. Because of this, it is generally used only when no other treatment options will prove sufficient to ensure 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. Hospital treatment may include regular group therapy sessions, scheduled eating, sleeping and recreational periods, and occasional interviews with doctors and nurses. 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. When outside supports are not adequate such as when there is no treating psychiatrist, or no psychotherapist, or housing is not adequate, the hospital may aid with coordination of care to resolve these issues.

Bipolar Disorder Treatment - Electroconvulsive Therapy (ECT)

One of the more successful non-medical therapies available to bipolar patients is Electroconvulsive Therapy (ECT). This is often referred to as "shock therapy." It involves passing an electric current through the brain to create an artificial seizure. ECT is typically used for people with severe depression that has not responded to other treatments and/or for people requiring non-medication treatment of depression.

The ECT procedure takes about 10 or 15 minutes, with an additional 30-45 minutes for preparation and recovery. It can be performed either during a hospital stay or as an outpatient procedure. ECT requires brief general anesthesia (i.e., the person is asleep during the procedure). Prior to the procedure, patients are given muscle relaxants to prevent damage from convulsions, which occur during the seizure. An electrode (or electrodes) is placed on the side or the front of the person's forehead. Then a short, controlled electrical current is passed through the brain.

Most patients receive 6 to 12 ECT treatments over the course of several weeks. Usually, treatment is administered two to three times a week until symptoms improve. Then, maintenance treatments will be administered at less frequent intervals. Though the procedure has the side effect of causing temporary short term-memory loss and concentration problems, it can work very well when other treatments fail.

Historically, ECT was thought of as a barbaric, inhumane treatment. This is not at all the case today. The modern method is well-researched and regulated. It is quite safe and provides very fast relief from forms of depression that will not otherwise respond to treatment. Because there are no body effects, it may be the safest treatment option for pregnant women or nursing mothers suffering from depression. It is not clear exactly how ECT helps people with depression. Many neurochemical and neuron aspects of brain functioning are altered during and after seizure activity. It is thought that when ECT is administered on a regular basis, these changes build upon one another, somehow reducing depression. In addition, ECT increases neuron growth in the brain, which may lead to relief from depressive symptoms.