Is electroconvulsive therapy still given in bipolar disorder and does repetitive transcranial magnetic stimulation offer more?

The evidence for the efficacy of electroconvulsive therapy (ECT) in depression is substantial. A recent systematic review and meta-analysis concluded that ECT is an effective treatment for depression and probably more effective than drug therapy.1 However, there are fewer research data available for the use of ECT in mania and in bipolar depression. These issues are addressed below before considering the role of repetitive transcranial magnetic stimulation (rTMS) as a potential alternative to ECT.