Shortly following the introduction of electroconvulsive therapy (ECT) in 1937, the initial reports on its use as refractory treatment for decreasing relapses in major psychoses were published. Because of the victorious application of psychotropic medication, the use of refractory ECT decreased significantly. In view of the fact that several patient relapse despite adequate continuation or refractory pharmacotherapy, awareness in ECT has increased in the last years.
In 1990 the American Psychiatric Association defined condition for ECT recommending its use for those patients with a persistent illness which has been intensely receptive to ECT, for whom either pharmacotherapy alone has not proven effective in putting a stop to reversion or cannot be safely administered and who are able to give permission and meet the terms with the treatment. [1] Many of the more current studies on ECT were retrospective, unrestrained or comprise of case reports only. Introduction Electroconvulsive therapy in the treatment of bipolar depression
Since its introduction, electroconvulsive therapy is a treatment used in mood disorders, especially in the depressive phases of bipolar disorder. The advance of this technique has made it a useful and current option both in the treatment of acute phases as in the prevention of recurrences. This treatment method has its controversies related to its effectiveness since it has many advantages as well as side effects. In this paper we are going to discuss the effectiveness of ECT in the treatment of bi-polar disorder.
The Effectiveness Of ECT In a Memorandum on the use of ECT produced by the Royal College of Psychiatrists in 1977, it was stated that there is substantial empirical evidence that ECT is an effective treatment in case of severe bi-polar disorder. Numerous studies have shown that the patients with depression who received ECT show greater improvement and fewer relapses than those not receiving ECT. Electroconvulsive therapy is frequently recommended for life-threatening mania, unless pharmacological regimens can take effect quickly.
Prior to the development of lithium and the neuro-leptics, ECT was the most effective treatment available for the rapid cycling of manic-depressive illnesses and was used quite often. [2] ECT is probably the safest and most effective treatment for major depression with psychotic features and is the treatment of choice for the client suffering concurrently from depression and heart disease, since tri-cyclic antidepressants may activate adrenergic mechanisms in the heart in addition to those in the brain and produce dangerous abnormalities in cardiac rhythm. Some specific signs and symptoms signify an enhanced response to ECT.
These include: psychomotor retardation or anxiety, early morning sleeplessness, persistent depression relatively unaffected by environmental changes, hallucinations, feelings of guilt or unworthiness, and diurnal rhythm. Reflex is also enhanced if the patient has a somewhat normal personality proceeding to or during attacks of depression. The patient with phobic behavior, an irregular level of depression, initial sleeplessness, broken sleep, or weakly attuned personality prior to depression will demonstrate a less positive response to ECT and relapse more often. [1-3]