Is ECT a viable option to treat depression in older adults with bipolar disorder who are vulnerable to cognitive side effects?

First used over eighty years ago, electroconvulsive therapy (ECT) is the oldest of the currently used biological treatments in psychiatry. ECT is indicated for severe depression, mania, treatment resistant schizophrenia psychosis, catatonia, and comorbid depression in dementia. ECT delivers a unilateral or bilateral electrical stimulus to the brain of an anesthetized patient to induce a generalized seizure. Response and remission rates of ECT in depression are high (73%-90% and 67%-73%, respectively) (1). In bipolar disorder (BD) the effectiveness of ECT has been shown for manic, depressive, and mixed episodes.