Nonpharmacotherapeutic Somatic Treatments for Bipolar Disorder (ECT, DBS, rTMS).

Nonpharmacotherapeutic, somatic treatments play an essential role in the management of bipolar disorder (BPD). Studies indicate that electroconvulsive therapy (ECT) is an effective treatment for acute mania, bipolar depression, and mixed affective states. Furthermore, it is an important second-line treatment option, as most pharmacotherapy-resistant patients respond to ECT. Specific challenges for patients with BPD receiving ECT include the risk of mood switching, and the need to evaluate and manage concurrent treatment with lithium and anticonvulsant mood stabilizers. Although the current evidence for alternative and newer physical treatments (e.g., transcranial magnetic stimulation, vagus nerve stimulation, stereotactic ablation, and deep brain stimulation) is preliminary, all of these novel methods show promising potential and merit further research.