Ketamine, TMS and ECT for Bipolar Depression
December 31, 2025 Chris Aiken
Ketamine should be used cautiously in bipolar disorder because it can trigger psychosis, and is best limited to short-term (one-month) treatment of severe depression that might otherwise require hospitalization. Electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) are both effective for bipolar depression, but ECT works faster and is preferred for severe cases with psychotic features, with remission rates as high as 95%. For bipolar depression, TMS is more effective when patients arrive in a positive mental state; encouraging enjoyable activities in the hour before treatment can improve response.