In his excellent review of the management of acute mania, Professor Keck does not mention an additional form of available treatment, no doubt because it is archaic and anecdotal.

In the early 1950s, when the only drugs available to treat mania were paraldehyde and barbiturates, patients were ill for months, and sometimes even died of exhaustion. In those days 'electroplexy' was given for everything, but a standard course of treatment of seven sessions of electro-convulsive therapy (ECT) over 3 weeks proved ineffective in manic patients. However, it became apparent that ECT applied twice daily, over 3 or at the most 4 days, usually brought the manic attack to an end.

I last used this treatment over 20 years ago, in circumstances where prompt restoration to health was vital. It was completely successful. The real difficulty was in obtaining anaesthetic cover twice daily. In drug-resistant cases such an approach might still have a place, with considerable savings in the time spent in hospital.