Hey WC, glad that Bird Feeder has jumped into this with personal experience and a good outcome. I'm also one of those people who thinks a lot about long term side effects and quality of life... that many people give psych meds kind of a free pass where if they had to live with the side effects themselves they might not.

Google scholar says that ECT is about %70 effective in bipolar depression. The side effects vary a lot. If I were in your shoes I'd seriously look at figuring out a med cocktail that isn't feeding dystonia. I mean I'd ask myself if I well and truly needed each med and eliminate one at a time. I don't know what you are taking and you may have already done that but in case not it is worth mentioning that meds can be reduced, dropped and switched.

I've got my headaches and weird neurological problems that kind of puts me off the idea of ECT plus my memory is already terrible and wouldn't want it worse and I don't have prominent tardive, dystonia or dyskenia at the moment but if I did I'd be switching meds.