P0318 - Extended maintenance electroconvulsive therapy for more than 9 years

Abstract

Maintenance electroconvulsive therapy (M-ECT) has been increasingly used to prevent relapse in patients with major psychiatric disorders. However, little is known about the long-term benefits and risks of M-ECT.

We report on a patient with recurrent episodes of depression with psychotic features who has been successfully treated with M-ECT for 9 years.

Case-report:

An 83-year old female patient was first admitted to our department at the age of 72 years, after a suicide attempt. She was diagnosed as having psychotic depression and received antidepressive medication with moderate effect. Relapses were multiple despite continuation medication. The failure of administered antidepressive medication to prevent relapse, necessitated the use of index, continuation and eventually maintenance ECT. The additional parallel use of mood stabilisers (lithium and lamotrigine) allowed us to lower the frequency of M-ECT. Attempts to discontinue M-ECT led to relapse and M-ECT is now seen as a life-long treatment for that patient. To date (2007) our patient has received 450 treatments. Her depression remains in remission over the last years. Despite the unusual large number of administered ECT, her memory function appears to be unimpaired and repeated assessments with the MMSE test have not revealed cognitive deterioration.

Discussion:

For some patients long-term M-ECT is the only effective treatment to prevent relapse in depression. The risks of long-term M-ECT, especially regarding its possible adverse effects on cognition, are still under research.

Our case-report provides support for the safety of expanded M-ECT which, in some cases, can be seen as a life-long treatment.