My diagnosis is Bipolar, not sure I, II. I have had many mixed state episodes, rapid cycling. First symptoms at about 13, not diagnosed until 35 even though many prior suicide attempts/risky behaviors. I have had ECT 49 times for the depression, effects just didn't hold for any real length of time (maybe a couple weeks), a couple caused manic episode. Why doesn't it work!!! I went to see Dr. K at Stanford and he felt that I wasn't a good candidate for ECT, but why, I don't know. I went by myself in a very depressed and couldn't really ask questions. Do you have any ideas, based on what I've told you, why that might be the case? Or do you disagree? Am I just crazy? It's suppose to work!!

Currently, I'm manic or in a mixed state, not sure which. I have never had physical symptoms like this before; nonstop unproductive movement, tapping feet, swinging leg when crossed, slapping leg, tapping fingers, etc. I stop one thing, say tapping my feet and the next thing I know I'm tapping my fingers!!! Is this common in manic state or am just absolutely crazy??? I am so scared! Please help.

Anxious - Laura

Thank you for your question Laura, it sounds like your problem is what we call treatment refractory or treatment resistant. It is difficult to be certain, but your doctor's opinion is going to be much more informed than mine. One thing is for sure, Dr. K is an expert and his opinion must be shared and discussed with you. Often, when treatments like ECT, or any treatment for that matter, are ineffective, I always think of whether there is another diagnosis to consider and address. In some patients with long standing mood instability, personality problems can emerge, which tends to make for more mood instability.

Medication options include combination medications (Lithium, Carbamazepine, Lamotrigine, Olanzapine, Quetiapine, Risperidone, Clozapine, and maintenance ECT with one treatment as an outpatient every 2 to 4 weeks). Another very important area is the psychological and social issues side of things. Again, your Doctor and Psychiatrist are in the best position to address these issues with you. Good luck.