Abstract
BackgroundMajor 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 presentationA 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.Conclusionswe 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.
Highlights
Major depressive disorder and associated mood syndromes are amongst the most common psychiatric disorders
Conclusions: we describe here an unusual case of delayed response to electroconvulsive therapy in the treatment of severe depressive disorder
There is a considerable variation in electroconvulsive therapy (ECT) dosing schedules in clinical practice
Summary
Major depressive disorder (MDD) and associated mood syndromes are amongst the most common psychiatric disorders. We outline a case of a female patient, who presented with severe depressive episode She initially failed to respond to her ECT treatment, until the 11th session, when she had a drastic improvement in her clinical presentation. She did not suffer from any episodes of severe mental illness, with no depression or mania She suffered from hypertension, type 2 diabetes mellitus, chronic obstructive pulmonary disease, and polymyalgia rheumatica for which she was on a reducing dose regime of prednisolone (4 mg OD on admission, reduced by 1 mg every 12 week). She was periodically anxious, requiring encouragement with food and drink intake Due to her good response previously, the treatment team arranged a course of ECT during the admission, and she was deemed to have capacity to consent to the treatment.
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