3 Treatment-Resistant Bipolar and Depression Options

I was searching for options for my bipolar depression, which does not seem to be lifting, and I thought my findings for treatment-resistant bipolar and depression options would be helpful to you.

I am on my second to last treatment for my bipolar disorder; the next one on the list is lithium. But I asked myself what after that? If lithium does not help me, what are the other options, there must be more, and there is. The first is Electroconvulsive Therapy (ECT), the second is Transcranial Magnetic Stimulation (TMS), and the last is Ketamine Therapy.

They all sound pretty scary at first, but after much research, I am calmer about the possibility of these options.

Since 2015 I have had depression for 90% of that time, the rest has been hypomanic spells, maybe a day or two of normality, but depression has been the central theme. So the options presented to me are appealing, and they are the last resort, but I have lived with this for so long now that something else has to be done.

I hope the lithium will do the trick, but if it doesn’t, and my psychiatrist agrees, I will go ahead with one or more of these options. I initially had the most concern about ECT, but after researching it, it is less scary.

Electroconvulsive Therapy

treatment-resistant bipolar and depression treatments image shows a stethoscope and the letters ect

Electroconvulsive Therapy is also known as shock treatment and has always reminded me of Frankenstein, which is why I probably had scary thoughts about it. And speaking of movies, One Flew Over the Cuckoos Nest did not help the image of ECT. The thinking behind this treatment is that it will shock the brain into behaving the way it should.

According to the American Psychiatric Association (APS), trained medical professionals administer the procedure under anaesthesia. The brain is given a seizure of one minute in length while the patient is asleep, and they wake up five to ten minutes later. The treatment is not just a one-off; it will be required six to twelve times, usually a few times a week.

It does sound extreme, and according to the APS, the potential hazards are memory loss and difficulty learning; there is the chance that you won’t remember the last few weeks before treatment. This part makes it seem scary, but memory problems do improve within a few months.

In my mind, if it helps treatment-resistant bipolar and depression, then mild memory loss, for the time being, is worth it as nothing can be worse than continuous depression.

Transcranial Magnetic Stimulation

a magnet pulling in iron filings into a pattern

I had never heard of this therapy, and I was intrigued by it as it sounded less daunting than ECT. According to the Mayo Clinic, it is a non-invasive procedure that uses magnets to stimulate nerve cells in the brain to treat treatment-resistant bipolar and depression.

Why it works is not precisely known, but they don’t understand fully why antidepressants work in most cases. But the theory behind this non-invasive procedure is an electromagnetic coil is placed by your head, and a pulse is sent through to your brain; it is painless, by the way. And it stimulates the nerve cells responsible for mood.

Unlike ECT, it does not require you to be sedated, and it does not affect the brain so much that seizures might occur, they are a few possible side effects such as a headache, a strange sensation on the scalp, tingling and twitches. In the case of bipolar, mania could be triggered, but this is very rare.

This one would be my choice of the three options should I require it.

Ketamine Therapy

a drip containing ketamine in a hospital

This is the newest kid on the block when it comes to treatment-resistance bipolar and depression. Ketamine is often thought of as a party drug where it is illegal. However, Ketamine Therapy is not a tablet you take; it is usually provided as a nasal spray for treatment. In the case of psychiatric treatment, it is usually infused into the body.

It is not just one treatment. It is infused over some time, and it is thought to have a good effect on the treatment of depression. Through the results from the treatment, it is quick to take effect.

According to Dr Levine:

… the traditional medications prescribed for depression are either not fast-acting enough or effective enough. “Ketamine is an effective alternative for some patients,”


I am intrigued by Ketamine Therapy, and I wondered about the side effects; and because it is new, there is not extensive research on it. But some of the side effects are the fact it wears off after 7 to 10 days, so you need to keep going back for it, which could prove expensive and time-consuming. It can also cause brain cell damage if the dosage is too high.

In Summary

I hope this has given you some hope that there are other options if antidepressants do not relieve depression and that there is also hope for those suffering from bipolar depression. I will keep you updated if I change onto lithium and how that goes; if it fails, I will try TMS first.


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Lou Farrell

Hi and welcome to Mentriz, where all manner of mental health issues are discussed, from anxiety to bipolar disorder. You can find what you are looking for by using the search function at the top of the screen. All articles are for information purposes and do not replace the advice of a doctor. I hope you find the website helpful and if you have a suggestion, please contact me.

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