Post-ECT hyperthermia and rapid mood improvements: a case report.

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Back to table of contents Previous article Next article DepartmentsFull AccessPost-ECT Hyperthermia and Rapid Mood Improvements: a Case ReportAnna Z. Antosik-Wojcinska, M.D., Dorota Bzinkowska, M.D., Lukasz Swiecicki, M.D., Ph.D., and Przemyslaw Bienkowski, M.D., Ph.D.Anna Z. Antosik-WojcinskaSearch for more papers by this author, M.D., Dorota BzinkowskaSearch for more papers by this author, M.D., Lukasz SwiecickiSearch for more papers by this author, M.D., Ph.D., and Przemyslaw BienkowskiSearch for more papers by this author, M.D., Ph.D.Published Online:1 Apr 2014https://doi.org/10.1176/appi.neuropsych.13020042AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: ECT is a safe and effective treatment for refractory major depression. Common side effects of ECT include headache, nausea, and mild memory impairment.1 ECT-associated hyperthermia has been rarely described.2,3We report a case of repeated post-ECT hyperthermia associated with rapid, transient mood improvements in a patient with drug-resistant depression.Case ReportMr. A, aged 26, was admitted to a tertiary-care psychiatric hospital with a major depressive episode resistant to mirtazapine, fluvoxamine, bupropion, and sertraline. The patient's medical history was unremarkable. Neurologic and neuroimaging examination revealed no abnormalities and Mr. A was qualified to bitemporal ECT with a standard anesthetic protocol (atropine, thiopental, succinylcholine). Twelve ECT sessions were performed biweekly, between 9:00 a.m. and 11:00 a.m., with the aid of the Thymatron apparatus. Two hours after the first session, the patient complained of flu-like symptoms, including headache and fever. A rise in his body temperature exceeding 2°C (up to 38.8°C) was documented by tympanic membrane and oral temperature measurements. In the afternoon, a marked improvement in mood and drive was reported by the patient and confirmed by an on-duty psychiatrist. In the evening, Mr. A felt a reduction in flu-like symptoms and 24 hours after ECT his mood and body temperature returned to baseline levels.A close correlation between post-ECT hyperthermia and transient improvements in depressive symptomatology was observed in sessions 1–7. When post-ECT hyperthermia was absent (session 2 and 4), no improvement or transient worsening in mental state was noted on the same day. A significant rise in body temperature (∆T>1°C) after sessions 1, 3, 5, and 7 was associated with rapid, transient mood improvements. Repeated physical and laboratory examinations showed no abnormalities. There was no relationship between the ECT-associated rise in body temperature and seizure duration or the course of anesthesia.Post-ECT hyperthermia was not observed beyond session 7. ECT sessions 8–12 resulted in a stable improvement in depressive symptomatology.DiscussionTo the best of our knowledge, this is the first report on post-ECT hyperthermia associated with rapid, transient mood improvements in an adult patient with drug-resistant depression. One may hypothesize that post-ECT hyperthermia may be a correlate of successful stimulation of brain structures (e.g., the hypothalamus) involved in mood and thermal homeostasis.1,4,5 More detailed studies are needed to quantify post-ECT alterations in brain and body temperature and their relationship to short- and long-term clinical outcomes.Institute of Psychiatry and Neurology, Warsaw, PolandSend correspondence to Dr. Bienkowski; e-mail: [email protected]edu.plThe authors report no financial relationships with commercial interests.References1 Sienaert P: What we have learned about electroconvulsive therapy and its relevance for the practicing psychiatrist. Can J Psychiatry 2011; 56:5–12Crossref, Medline, Google Scholar2 Vilkin MI: Fever following electroshock. Am J Psychiatry 1962; 118:946–947Crossref, Medline, Google Scholar3 Bryson EO, Pasculli RM, Briggs MC, et al.: Febrile reaction with elevated CPK after a single electroconvulsive therapy (ECT) in an adolescent patient with severe bipolar disorder. J ECT 2012; 28:70–71Crossref, Medline, Google Scholar4 Salerian AJ, Saleri NG, Salerian JA: Brain temperature may influence mood: a hypothesis. Med Hypotheses 2008; 70:497–500Crossref, Medline, Google Scholar5 Bolwig TG: How does electroconvulsive therapy work? Theories on its mechanism.Google Scholar FiguresReferencesCited byDetailsCited ByTransient Febrile Episodes After Electroconvulsive Therapy (ECT)19 February 2021 | The Journal of ECT, Vol. 37, No. 3Post–Electroconvulsive Therapy HyperthermiaThe Journal of ECT, Vol. 33, No. 3SSRN Electronic Journal Volume 26Issue 2 Spring 2014Pages E21-E21 Metrics PDF download History Published online 1 April 2014 Published in print 1 April 2014