Severe anorexia nervosa, co-occurring major depressive disorder and electroconvulsive therapy as maintenance treatment: a case report

Outi Poutanen,Kaisa Perko,Kaija Huuhka

doi:10.1186/1757-1626-2-9362

Outi Poutanen, Kaisa Perko + Show 1 more

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https://doi.org/10.1186/1757-1626-2-9362

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Journal: Cases Journal	Publication Date: Dec 1, 2009
Citations: 19	License type: CC BY 2.0

Affiliation: Tampere University, Tampere University Hospital

Abstract

IntroductionIt is difficult to treat patients who, in addition to having severe anorexia nervosa, also have severe symptoms of major depressive disorder and a tendency for impulsive acting out behaviour. Our case report considers the feasibility of maintenance electroconvulsive therapy in such complicated cases.Case presentationThis is a case report of a woman with anorexia nervosa and co-morbid severe major depressive disorder who was treated with electroconvulsive therapy as a maintenance treatment.The maintenance electroconvulsive therapy was conducted without immediate complications. It had a positive effect on the patient's depressive symptoms and lability and her general wellbeing, although some cognitive deficits were observed.ConclusionThe maintenance electroconvulsive therapy seemed to support recovery in a case of refractory anorexia nervosa and a tendency for labile mood. The symptoms of co-occurring major depressive disorder were partly relieved and maintenance electroconvulsive therapy had some positive effect on weight gain.

Highlights

It is difficult to treat patients who, in addition to having severe anorexia nervosa, have severe symptoms of major depressive disorder and a tendency for impulsive acting out behaviour
The symptoms of co-occurring major depressive disorder were partly relieved and maintenance electroconvulsive therapy had some positive effect on weight gain
There is no consensus on treatment guidelines in eating disorders [3], and the role of antidepressants (AD) is not clear [4], in case of co-existing major depressive disorder (MDD) using AD is obvious

Summary

Conclusion

ECT seemed to have a stabilizing effect on the mood and some positive effect on weight gain. The changes in symptoms were transient with ECT but slightly more stable with mECT with a frequency of at least once in two weeks. We suggest that ECT is a treatment option when a patient has an eating disorder and co-morbid severe MDD. As maintenance treatment mECT seemed to support recovery in a case of refractory anorexia nervosa and a tendency for labile mood. The risk of memory dysfunctions after mECT, requires further research

Introduction

Discussion

12. American Psychiatric Association: The Practice of Electroconvulsive Therapy

American Psychiatric Association

Ferguson JM