September 16, 2020

Suicide risk in bipolar patients can be reduced by ECT

One of the largest ever studies of patients with untreatable bipolar disorder has shown that ECT (Electroconvulsive Therapy) was able to reduce suicide risk by 84 per cent in high-risk patients, as well as giving effective treatment to around 72 per cent of sufferers. Bipolar disorder, among the most common mental health disorders where patients exhibit emotional instability and may experience very severe mood swings. Bipolar disorder can cause mixed states of mania and depression; this mix can lead to an increased risk of suicide, since sufferers may simultaneously experience both the symptoms of depression (such as the sense of guilt and worthlessness) and symptoms of mania (such as increased activity and tendency to act without thinking twice). Most patients can control the condition via prescription drugs, but almost a third of patients are resistant to treatment. Now, the largest-ever study to follow bipolar patients and treatment from a single centre has confirmed that ECT can reduce suicide risk and allow a majority of patients affected by the treatment-resistant bipolar disease to return to a more normal life. This work is presented at the ECNP conference, after part-publication in the peer-reviewed journal The World Journal of Biological Psychiatry. The treatment showed great success in treating bipolar sufferers, with remission rates of over 60 per cent for symptoms characteristic of bipolar “mixed states”, such as emotional over-reactivity, motor hyperactivity, aggressiveness and persecutory delusions, uncooperativeness, catatonia and associated movement disturbances. The public tends to have a negative view of ECT, largely based on media representation of the very different psychiatric world of the 1950s, but patients and psychiatrists are generally positive about the effects of ECT on otherwise untreatable or difficult to treat mental health conditions. Modern ECT is given under general anesthetic and can lead to rapid recovery from Major Depression (the main side effect is a possible transitory loss of recent memory). It’s normally given 2 to 3 times per week, with between 6 and 16 treatments needed to show a positive effect.
Prejudice against modern ECT unjustly stigmatizes both patients and psychiatry, and denies treatment to seriously-ill patients”.
“ECT is used for major depression, but much less so for the other phases of Bipolar Disorder, especially for so-called mixed states, which have lower visibility. We find that many patients with treatment-resistant bipolar catatonic and mixed states are misdiagnosed as having schizophrenia.
The study again shows that ECT can be a life-saving treatment and should not be withheld to patients suffering from difficult to treat mood disorders such as bipolar disorder. Although we should acknowledge adverse effects like (mostly temporary) memory impairments, these results show how well, and often how fast the response to ECT can be. This effectiveness generally outweighs the adverse effects in these severely ill patients, who otherwise might suffer for much longer or not have effective treatment at all. Unfortunately, despite the long-term evidence, ECT is still viewed as a controversial treatment by the general public and the media, but also by many patients and relatives. This is also the case in Italy where very few centres can offer ECT nowadays. This prejudice against modern ECT unjustly stigmatizes both patients and psychiatry, and denies treatment to seriously-ill patients”.
(The author is a student of Nursing. Views are his own) [email protected]

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