Review of Non-Pharmacological Treatments For Rapid-Cycling Bipolar Disorder: ECT Is Included

Out on PubMed, from authors in India and the UK, is this review:

Role of adjunctive nonpharmacological strategies for treatment of rapid-cycling bipolar disorder.

Chakrabarti S, Jolly AJ, Singh P, Yadhav N.World J Psychiatry. 2023 Aug 19;13(8):495-510. doi: 10.5498/wjp.v13.i8.495. eCollection 2023 Aug 19.PMID: 37701540 

The abstract is copied below:

Rapid-cycling bipolar disorder (RCBD) is a phase of bipolar disorder defined by the presence of ≥ 4 mood episodes in a year. It is a common phenomenon characterized by greater severity, a predominance of depression, higher levels of disability, and poorer overall outcomes. It is resistant to treatment by conventional pharmacotherapy. The existing literature underlines the scarcity of evi-dence and the gaps in knowledge about the optimal treatment strategies for RCBD. However, most reviews have considered only pharmacological treatment options for RCBD. Given the treatment-refractory nature of RCBD, nonpharmacological interventions could augment medications but have not been adequately examined. This review carried out an updated and comprehensive search for evidence regarding the role of nonpharmacological therapies as adjuncts to medications in RCBD. We identified 83 reviews and meta-analyses concerning the treatment of RCBD. Additionally, we found 42 reports on adjunctive nonpharmacological treatments in RCBD. Most of the evidence favoured concomitant electroconvulsive therapy as an acute and maintenance treatment. There was pre-liminary evidence to suggest that chronotherapeutic treatments can provide better outcomes when combined with medications. The research on adjunctive psychotherapy was particularly scarce but suggested that psychoeducation, cognitive behavioural therapy, family interventions, and supportive psychotherapy may be helpful. The overall quality of evidence was poor and suffered from several methodological shortcomings. There is a need for more methodologically sound research in this area, although clinicians can use the existing evidence to select and individualize nonpharmacological treatment options for better management of RCBD. Patient summaries are included to highlight some of the issues concerning the implementation of adjunctive nonpharmacological treatments.

Keywords: Adjunctive therapy; Bipolar disorder; Nonpharmacological treatment; Rapid-cycling bipolar disorder.

The article is here.

And from the text:

This review of non-pharmacological treatments for rapid-cycling bipolar disorder includes a good literature review of ECT for this indication.

Interestingly, the two added brief case reports from their own experience (see directly above) are equivocal.

It seems strange to me that there is still reluctance to embrace ECT as a treatment for all phases of bipolar disorder, despite plenty of good evidence.