Electroconvulsive therapy has been shown to be highly effective in treating depressed and manic episodes. While some experts argue that because of the strong evidence supporting its efficacy, ECT should be a first-line treatment for psychotic depression (both in bipolar disorder and in unipolar depression) it is usually reserved as a second-line, or third-line treatment, after multiple medication strategies have not worked. Additionally, the availability of ECT varies widely from state to state, and even within states.
Strong indications for the use of ECT in bipolar disorder include:
• Severe psychotic depression
• Severe depression or mania in a pregnant woman (please note the electrical current travels between the electrodes placed on the head and does not make it to the womb and the fetus)