Electroconvulsive therapy in a young adult patient with treatment-resistant depression and electroencephalogram epileptiform activity

Abstract

Introduction Electroconvulsive therapy (ECT) causes a seizure which is different from a convulsion in epilepsy. Despite this, ECT remains a challenge in patients with comorbid epileptiform activity. Our aim was to indicate the importance and safety of the ECT in a young adult with treatment-resistant depression (TRD) and electroencephalogram (EEG) epileptiform activity.

Case report A 21-year-old female patient was scheduled for ECT due to TRD and suicidal behavior. During the preparation for ECT, EEG epileptiform activity was noticed, and upon the anticonvulsant medication administration, the patient received the acute ECT, combined with quetiapine XR 600 mg/d, duloxetine 60 mg/d and pregabalin 450 mg/d, since the disease was life threatening. We noted a significant increase in the stimulus dose, i.e., elevation in the convulsive threshold during ECT. The clinical outcome was without adverse events and with a reduction of the depression severity. The continuation of the maintenance ECT, psychopharmacotherapy and psychotherapy was planned.

Conclusion ECT is the most effective therapy for TRD, while the presence of EEG epileptiform activity is not a contraindication for ECT, with the advantage of the ECT Thymatron IV device (Somatics Inc., Venice, FL, USA), as a four-channel digital EEG machine, allowing us to record and analyze EEG.

Keywords: depression; ECT; EEG; young adults; suicidal behavior