Abstract:
BACKGROUND:Electroconvulsive therapy (ECT) can be life-saving in treating depression, even for high-risk cardiac patients. A 56-year-old man with type 2 diabetes and dilated cardiomyopathy, using both a defibrillator and an experimental cardiac contractility modulator, had had episodes of severe depression superimposed on dysthymia for 27 years, with a current exacerbation over the past 2 years, and little response to antidepressant treatment. METHOD:He received a course of 12 ECTs (6 right-unilateral and 6 left-anterior/right-temporal electrode placements). RESULTS:After these, he was judged moderately but not dramatically improved. DISCUSSION:Serious adverse events, such as myocardial infarction, lethal arrhythmias, and cardiac rupture are possible in these high-risk patients, especially those with ejection fractions <50%, previous myocardial infarction, or significant arrhythmias. This case illustrates the complex decision-making involved and the need for close interdisciplinary collaboration entailed in preparing a high-risk patient with an implanted device for ECT.
journal_name
Psychosomaticsjournal_title
Psychosomaticsauthors
Lynch AM,Pandurangi AK,Levenson JLdoi
10.1176/appi.psy.49.4.341subject
Has Abstractpub_date
2008-07-01 00:00:00pages
341-4issue
4eissn
0033-3182issn
1545-7206pii
49/4/341journal_volume
49pub_type
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