Non-pharmacological somatic treatments for bipolar depression
Non-pharmacological somatic treatments have a long history in the care of patients with bipolar disorder. Indeed, electroconvulsive therapy (ECT) is the biological intervention with the longest history of continuous use in psychiatry, and it remains the most effective acute treatment available for either unipolar or bipolar depression or mania. This chapter discusses the therapeutic properties of ECT in the acute treatment of bipolar depression, mania, and unipolar depression. It also reviews the essential limitations of ECT—its adverse cognitive effects and high rates of relapse. The chapter introduces new developments in this field that have created forms of ECT administration that dramatically reduce the frequency and severity of adverse cognitive effects. These include critical alterations in the administration of ECT, such as the use of ultrabrief electrical stimuli, and the development of new forms of convulsive therapy, particularly Magnetic Seizure Therapy (MST) and Focal Electrically Administered Seizure Therapy (FEAST). Additional novel interventions such as repetitive transcranial magnetic stimulation (rTMS), deep brain stimulation (DBS), and vagus nerve stimulation (VNS) are also reviewed.
KeywordsDeep Brain Stimulation Vagus Nerve Stimulation Electroconvulsive Therapy Bipolar Depression Unipolar Depression
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