Atrial fibrillation induced by electroconvulsive therapy (ECT) is rare, with only 3 reported cases. None of those cases involved either young healthy patients or right unilateral ECT. We report a 46-year-old healthy male observed to be in atrial fibrillation immediately after electrical induction of the 25th administration of right unilateral ECT. Diltiazem was administered, and he spontaneously cardioverted. After a negative cardiology workup, he safely resumed ECT. Atrial fibrillation was most likely triggered by autonomic imbalance due to the combination of electrical induction, seizure, and medication.
High frequency repetitive transcranial magnetic stimulation (rTMS) was approved by the US Food and Drug Administration in 2008 to treat major depressive disorder in those who did not respond to at least 1 antidepressant trial. Previous studies have shown that both high frequency rTMS to the left dorsolateral prefrontal cortex (DLPFC) and low frequency rTMS to the right DLPFC have antidepressant efficacy in treatment-resistant depression. Although rTMS has been widely used in the treatment of depression, very few studies of rTMS in patients with depersonalization disorder (DPD) have been published so far. DPD involves persistent or recurrent experiences of unreality and feelings of detachment causing distress or functional impairment while insight remains intact. The prevalence of DPD is approximately 1% to 2%. Studies of the pharmacological treatment of DPD are limited, and medications have proven to be of limited benefit. We present the case of a 30-year-old man with major depressive disorder and DPD who did not respond to pharmacotherapy. After the patient was treated with low frequency rTMS to the right DLPFC followed by high frequency rTMS to the left DLPFC, there was a significant reduction in his depersonalization symptoms. Given its effectiveness in our patient, the use of both low frequency rTMS to the right DLPFC and high frequency rTMS to the left DLPFC for treatment of DPD should be further explored.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.