On the last track, we discussed three difficulties in
prescribing medication to bipolar children. These three difficulties
regular doses; rebellious teens; and side effects. We also
included two techniques for combating these difficulties,
which were Medication Routine and Other Non-Medicinal
On this track, we will examine three non-medicinal treatments
for depression. These
treatments include electroconvulsive therapy; light therapy; and repeated
transcranial magnetic stimulation.
3 Non-Medical Treatments for Depression
1. Electroconvulsive Therapy
The first non-medicinal antidepressant therapy is electroconvulsive
therapy, or ECT. Many parents are reluctant to try this method
because of the stigma that goes with it. Often, parents find it disturbing
that their child will be subject to electric shocks and seizures. However,
Drs. Mark Bertagnoli and Carrie Borchardt completed a study in which 67 percent
of bipolar children treated with ECT improved. This procedure is usually
given to a child or adolescent client three times the first week, and twice
each week after for a total of six to nine or fifteen to twenty completely
painless treatments, depending on the degree of response.
procedure, the client is put to sleep with a short-acting barbiturate and a
drug is administered to paralyze the muscles to prevent contracting and fractures. An
electrode is then placed above the temple of the non-dominant side of the head
and a second in the middle of the forehead. A very small current of electricity
is passed through the brain causing a seizure. The client breathes pure
oxygen through a mask and his or her heart is monitored as well as the seizure
For adolescents, the seizure threshold is extremely low and
the first treatment is administered at the lowest possible level. However,
adolescents develop tolerance quickly and by the third or fourth treatment,
the energy is increased. After the treatment, many clients experience
temporary memory loss and confusion, but these side effects vanish after an
hour or so.
Parents Unsure about ECT
Tiffany was an eleven year old bipolar client whose depressive states
were such that many of her medications did very little and were never enough
to keep her stable. She said she was frightened by the thoughts that
came to her during depression and hated the lack of energy she had. I
suggested to her mother, Lucy, that Tiffany might benefit from ECT. At
first, Lucy was reluctant, having formed certain opinions about the procedure.
help Lucy see the benefit of ECT, I gave her several pamphlets and books to
read to help her learn more about it. After a few weeks, Tiffany was
in her first session. Because of the degree of her depression, Tiffany
required more treatment sessions than many clients, 20 in all. However,
once she had finished her sessions, Tiffany stated, "I have so much more
energy now, and it’s not the kind I have when I’m crazy. I
feel good about myself and the bad thoughts are gone." Think of
your "Tiffany". Could her deep depression benefit from ECT?
2. Light Therapy
The second non-medicinal antidepressant treatment is light therapy. This
therapy is most effective for clients whose depression is directly affected
by the seasonal change and lack of sunlight. To combat this depression,
I suggest to many of my clients to try buying a light box. A
light box is a specially designed light that simulates sun rays by emitting
The timing of circadian rhythms varies in relation to
mood in a predictable way in rapid-cycling clients. Specifically, the
phase of temperature, the excretion of a metabolite or norepinephrine and melatonin
secretion all occur earlier in the day in a hypomanic state than in a depressed
state. This bright light can shift the phase of circadian rhythms, with
morning light shifting the rhythms to an earlier time and evening light delaying
them. Manipulating these phase shifts could treat the depressed phase
of the illness.
Tony was a 12 year old bipolar client whose depressive states made
an all time low in the months of October to March. Tony stated, "I
like the summer. When I feel bad, it’s not the same kind of bad
as in the winter. When it’s cold and dark, I feel like dirt." To
treat his seasonal affective disorder, I suggested to Tony’s father Mark
that Tony be treated with a light box.
For his light sessions, Tony sat
about two feet away from the light box while it was on. Every
minute or so, Tony was instructed to look into the light for a few seconds. While
he was not looking at the light, Tony played video games, read a book, or watched
television. His treatment only required he use the light box fifteen minutes a day. In about two weeks, Tony reported a more stable condition. Keep
in mind that children under the age of eight have a higher sensitivity to light
and should be exposed to a much less intense light box.
3. Repeated Transcranial Stimulation
In addition to ECT and light therapy, a third non-medicinal antidepressant
therapy is repeated transcranial magnetic stimulation or r-TMS. This
treatment involves using a coiled magnet aimed at the left prefrontal cortex of the brain, which may be able to speed up the motor nerve pathways in clients
suffering from depression. This treatment involves a client sitting
in a lounge chair while a small but powerful coiled electromagnet is placed
on the scalp. This creates a strong magnetic field that passes through
When this rapidly changing magnetic field encounters the
brain’s nerve cells, it causes an electric current that depolarizes
them. The client receives forty stimulations in two seconds and this
is repeated twenty times There are very low side effects, such as an
occasional headache, but this treatment is in its infancy, and more research
must be done to determine whether it is effective on children and adolescents.
On this track, we presented three non-medicinal treatments for depression. These
three treatments included electroconvulsive therapy; light therapy;
and repeated transcranial magnetic stimulation.
On the next track, we will examine the three key
aspects of stress on bipolar child clients: biological processes;
social factors; and transitions. We will also include three techniques
to reduce these stresses, which are Acclimation, Point System and Transition
Peer-Reviewed Journal Article References:
Gellersen, H. M., & Kedzior, K. K. (2018). An update of a meta-analysis on the clinical outcomes of deep transcranial magnetic stimulation (DTMS) in major depressive disorder (MDD). Zeitschrift für Psychologie, 226(1), 30–44.
Gilkes, M., Perich, T., & Meade, T. (2019). Predictors of self-stigma in bipolar disorder: Depression, mania, and perceived cognitive function. Stigma and Health, 4(3), 330–336.
Meyerhoff, J., & Rohan, K. J. (2016). Treatment expectations for cognitive-behavioral therapy and light therapy for seasonal affective disorder: Change across treatment and relation to outcome. Journal of Consulting and Clinical Psychology, 84(10), 898–906.
Tsai, J., Huang, M., & Lindsey, H. (2019). Perceptions and knowledge related to electroconvulsive therapy: A systematic review of measures. Psychological Services. Advance online publication.
Online Continuing Education QUESTION
What are three non-medicinal treatments that can be used for depression in
bipolar child clients?
To select and enter your answer go to