Case report: delayed response after electroconvulsive therapy in a patient with major depressive disorder

Abstract

Background Major depressive disorder and associated mood syndromes are amongst the most common psychiatric disorders. To date, electroconvulsive therapy (ECT) is considered the most effective short-term treatment for patients with severe or treatment-resistant depression. In clinical practice, there is considerable variation in the ECT dosing schedule, with the number of sessions typically ranging from 6 to 12, with early antidepressant effects being predictive of increased positive outcomes. We describe here an unusual case of a female patient with severe depression who did not respond to ECT until the 11th session, after which she had shown a drastic improvement in her mental state. Case presentation A 75-year-old female presented to the old age psychiatry inpatient unit with new onset dysphoric mood, anhedonia, and severe negativity. She scored 23 on the 17-item Hamilton Rating Scale for Depression (HAM-D), and was rated 6 on Clinical Global Impression severity (CGIS) by the responsible clinician. She suffered from post-natal depression fifty years ago and was successfully treated with ECT. She was therefore initiated on a course of ECT treatment. Her condition initially deteriorated, displaying features of catatonia and psychosis, unresponsive to ECT treatment or concurrent psychotropic medications. After 11th ECT session, she started to show signs of clinical improvement and returned close to her baseline mental state after a total of 17 ECT sessions. She remained well 3 months post-treatment, scoring 4 on HAM-D, Clinical Global Improvement or change (CGI-C) rated as 1 (very much improved). The diagnosis was ICD-10 F32.3 severe depressive episode with psychotic symptoms. Conclusions we describe here an unusual case of delayed response to electroconvulsive therapy in the treatment of severe depressive disorder. Studies have shown the number of acute ECT treatments to be highly variable, affected by a number of factors including treatment frequency, condition treated and its severity, the ECT technical parameters, as well as concurrent use of pharmacological treatment. This may call for re-consideration of the current ECT treatment guidelines, requiring more research to help stratify and standardize the treatment regime.

Diagnosis and Treatment of Low-Grade Marginal Zone B-cell Lymphoma With Psychiatric Overlap

“…Early diagnosis in this case could have potentially been facilitated by heightened awareness and screening for organic causes of psychiatric symptoms, particularly in elderly patients presenting with new or significantly altered mental health symptoms. Earlier integration of neuroimaging, more frequent psychiatric evaluations, and perhaps earlier consideration for bone marrow biopsy upon initial presentation of unexplained neurocognitive changes might have led to a quicker understanding of the underlying lymphoma [ 6 , 7 ].…”

Current knowledge and attitudes of psychiatric nurses toward electroconvulsive therapy

“…ECT could be a life‐saving modality in severe cases of depression in decreasing suicidal ideations and suicidal attempts (Kellner & Patel, 2018; Lonergan et al, 2021). ECT is now commonly used primarily for affective disorders in addition to other psychotic conditions (AlHadi et al, 2017; Chen et al, 2021; Lonergan et al, 2021).…”