I was very delighted to have read this article which provides a comprehensive, stepwise approach to assessing and managing this frequently encountered, complex and recurrent illness.
The author reminds us of the risk implications associated with Bipolar Affective Disorder, which include physical health insults and co morbidity .
One could not help but appreciate the welcome additions to the management of this disorder, such as a greater emphasis on psychological intervention. These, though evidence based, in reality at not readily accessible, given the rapidly declining availability of these services.
On the other hand, I was disappointed by the absence of ECT as a treatment modality for Bipolar depression. I note that the NICE guidance has continued to include ECT as treatment in mania. Whilst I appreciate the apparent difficulty in providing evidence based information for this treatment modality, it continues to be of superior efficacy in the treatment of depressive illness. This is especially noticeable in individuals who have had previous good response to ECT and also in those who struggle to tolerate untoward effects of pharmacological preparations.
I note that ECT may have been included in NICE Guidance in the past. It is also worth noting , that ECT continues to play a significant role in secondary care. Many of my Consultant colleagues and myself , utilise this treatment to good effect.
It therefore seems farcical to omit this, given the quick response for the client, the minimal side effect profile and the relatively low cost effectiveness of the procedure.
Rapid Response:
I was very delighted to have read this article which provides a comprehensive, stepwise approach to assessing and managing this frequently encountered, complex and recurrent illness.
The author reminds us of the risk implications associated with Bipolar Affective Disorder, which include physical health insults and co morbidity .
One could not help but appreciate the welcome additions to the management of this disorder, such as a greater emphasis on psychological intervention. These, though evidence based, in reality at not readily accessible, given the rapidly declining availability of these services.
On the other hand, I was disappointed by the absence of ECT as a treatment modality for Bipolar depression. I note that the NICE guidance has continued to include ECT as treatment in mania. Whilst I appreciate the apparent difficulty in providing evidence based information for this treatment modality, it continues to be of superior efficacy in the treatment of depressive illness. This is especially noticeable in individuals who have had previous good response to ECT and also in those who struggle to tolerate untoward effects of pharmacological preparations.
I note that ECT may have been included in NICE Guidance in the past. It is also worth noting , that ECT continues to play a significant role in secondary care. Many of my Consultant colleagues and myself , utilise this treatment to good effect.
It therefore seems farcical to omit this, given the quick response for the client, the minimal side effect profile and the relatively low cost effectiveness of the procedure.
1. NICE, CG 185, sec 1.5.11, Sept 2014
2. NICE, CG 185, 2006
Competing interests: No competing interests