Electroconvulsive therapy and anticoagulation after pulmonary embolism: a case report

Abstract

Introduction: Electroconvulsive therapy (ECT) is considered the most effective treatment for catatonia regardless its underlying condition. The rigid fixed posture and immobility observed in catatonia may lead to several clinical complications, of which, pulmonary embolism (PE) is one of the most severe. The rapid improvement of the psychiatric condition in catatonia-related PE is essential, since immobility favors the occurrence of new thromboembolic events and further complications. In that scenario, ECT should be considered, based on a risk-benefit analysis, aiming at the faster resolution of the catatonia. Methods: Case report and literature review. results: A 66-years-old woman admitted to the psychiatric ward with catatonia due to a depressive episode presented bilateral PE. Clinically stable, but still severely depressed after a trial of antidepressants, she was treated with ECT in the course of full anticoagulation with enoxaparin. After five ECT sessions, her mood was significantly better and she was walking and eating spontaneously. She did not present complications related either to PE or to anticoagulation. After the eighth ECT session, she evolved with hypomania, which was managed with oral medication adjustments. The patient was completely euthymic at discharge. conclusion: The case we presented provides further evidence to the anecdotal case reports on the safety of ECT in the course of concomitant full anticoagulant therapy after PE, and illustrates how, with the proper precautions, the benefits of ECT in such condition might outweigh its risks.

Catatonia in older adults: A systematic review

“…Although there are no absolute contraindications for the use of ECT in older patients and it is considered a safe and well-tolerated treatment, medical risks must be evaluated individually[ 143 , 150 ]. There are case reports of catatonic patients with unstable or potentially unstable clinical conditions, such as a 95-year-old pacemaker user[ 156 ], full anticoagulation after pulmonary embolism[ 157 ], a 100-year-old patient with severe aortic stenosis[ 158 ], deep venous thrombosis[ 159 ]; that illustrates how, with the proper precautions, the benefits of ECT in such conditions might outweigh its risks.…”

Coronary arterial disease after electroconvulsive therapy: a case report

“…Even among the elderly population, an age group in which more cardiac complications succeeding ECT can be expected, the statement that it does occur is still controversial, due to sparse research on this important topic 3 . There is no consensus regarding guidelines for ECT pre-evaluation 3,12 , and, although there are no absolute contraindications for the procedure, some case reports describe fatal outcomes due to other ECT cardiac complications and it is known that both hypertension and preexisting cardiac diseases may increase their risk [2][3][4][5][6][7]13 . One possible complication of ECT is Takotsubo cardiomyopathy, a transient left-ventricular dysfunction that may occur after a physical stressor and which may increase the risk of myocardial infarction 14 .…”