Nonresponse to Electroconvulsive Therapy (ECT) in a Patient with Depression, Substance Abuse and Personality Disorder
DOI:
https://doi.org/10.12970/2310-8231.2014.02.02.1Keywords:
Non-response to ECT, ECT and substance abuse, ECT and personality disorder, heterogeneity of depression, ECT consultation.Abstract
The authors report the case of a patient with a history of episodic, severe clinical depression who demonstrated an apparent absence of response to ECT. His illness was complicated by substance abuse and personality disorder. The vicissitudes of his course of treatment are described and the literature on ECT in depressed patients with substance abuse and personality disorder is reviewed. The heterogeneity of depression, and its relation to the ECT consultation process, is briefly discussed.
References
Comprehensive Textbook of Psychiatry. Baltimore, the Williams and Wilkins Company 1967.
Kolb LC. Modern Clinical Psychiatry. Philadelphia. W.B. Saunders 1973.
Weiner RD, Coffey CE. Indications for use of electroconvulsive Therapy. In Francis AJ and Hales RE. Review of Psychiatry, Volume 7. Washington, DC, American Psychiatric Press 1988.
Dunn CG, Quinlan D. Indicators of ECT response and non-response in the treatment of depression. J Clin Psychiatry 1978; 39: 620-2.
Pettinati HM, O’Brien CP, Dundon WD. Current status of co-occurring mood and substance use disorders: a new therapeutic target. Am J Psychiatry 2013; 170: 23-30. http://dx.doi.org/10.1176/appi.ajp.2012.12010112
Newton-Howes G, Tyrer P, Johnson T. Personality Disorder and the outcome of depression: meta-analysis of published studies. Br J Psych 2006; 188: 13-20. http://dx.doi.org/10.1192/bjp.188.1.13
Kellner CH, Greenberg RM, Murrough JW, Bryson EO, Briggs MC. ECT in treatment-resistant depression. Am J Psychiatry 2012; 169: 1238-44. http://dx.doi.org/10.1176/appi.ajp.2012.12050648
Pande AC, Grunhaus L J. ECT for depression in the presence of myasthenia gravis. Convulsive Therapy 1990; 6(2): 172-5.
Davis L, Uezato A, Newell JM, Frazier E. Major depression and comorbid substance abuse disorders. Current Opinion in Psychiatry 2008; 21: 14-8. http://dx.doi.org/10.1097/YCO.0b013e3282f32408
Davis LL, Rush JA, Wisniewski SR. Substance use disorder comorbidity in major depressive disorder: a confirmatory analysis of the Sequenced Treatment Alternatives to Relieve Depression cohort. Compr Psychiatry 2005; 46: 81-9. http://dx.doi.org/10.1016/j.comppsych.2004.07.025
Nunes EV, Levin FR. Treatment of co-occurring depression and substance dependence. Psychiatr Ann 2008; 38: 730-8. http://dx.doi.org/10.3928/00485713-20081101-05
American Psychiatric Association. Practice Guideline for the Treatment of Patients with Substance Use disorders, 2nd ed. psychiatryonline.org/data/Books/prac/SUD2ePG_04-28-06.pdf. (accessed September 13, 2014).
Sareen J, Enns M, Guertin JE. The impact of clinically diagnosed personality disorder on acute and one-year outcomes of electroconvulsive therapy. J ECT 2000; 16: 43-51. http://dx.doi.org/10.1097/00124509-200003000-00006
DeBatista C, Mueller K. Is electroconvulsive therapy effective for the depressed patient with borderline personality disorder? J ECT 2001; 17: 91-8. http://dx.doi.org/10.1097/00124509-200106000-00002
Snyder R, Liebman LS, Simon AB, Kellner CH. Does heterogeneity of depression diagnosis harm those with severe mood disorders? Medical Hypotheses 2013; 81: 316-8. http://dx.doi.org/10.1016/j.mehy.2013.04.011
American Psychiatric Association Committee on Electroconvulsive Therapy. The practice of electroconvulsive therapy: recommendations for treatment, training and privileging, 2nd ed. Washington DC: American Psychiatric Association 2001.
Kellner CH, Popeo DM, Pasculli RM, Briggs MC, Gamss S. Appropriateness for electroconvulsive therapy (ECT) can be assessed on a three-item scale. Med Hypotheses 2012; 79: 204-6. http://dx.doi.org/10.1016/j.mehy.2012.04.036
Casher MI. “There’s no such thing as a patient”: Reflections on the significance of the work of D.W. Winnicott for modern inpatient psychiatric treatment. Harv Rev Psychiatry 2013; 21: 181-7.
Kraepelin E. Manic-depressive insanity and paranoia. Edinburgh; Livingstone 1921.
Keller MB. Diagnostic issues and clinical course of unipolar depression. In: Francis AJ, Hales RE, Eds. American Psychiatric Press review of psychiatry, vol. 7. Washington DC: American Psychiatric Press 1988; 188-212.
Merikangas KR, Wicki W, Angst J. Heterogeneity of depression: classification of depressive subtypes by longitudinal course. Br J Psychiatry 1994; 164: 342-8. http://dx.doi.org/10.1192/bjp.164.3.342
Fox HA. The natural course of depression: Kraepelin and beyond. Harvard Review of Psychiatry 2002; 10: 249-53. http://dx.doi.org/10.1080/10673220216225
McGuffin P, Riley B, Plomin R. Toward behavioral genomics. Science 2001; 291: 1232-49. http://dx.doi.org/10.1126/science.1057264
Bosches RA, Manschreck TC, Konigsberg W. Genetics of schizophrenia: a model accounting for their persistence and myriad phenotypes. Harv Rev Psychiatry 2012; 20: 119-29. http://dx.doi.org/10.3109/10673229.2012.694321
Bonvicini C, Minelli A, Scassellati C, Bortolomasi M, et al. Serotonin transporter gene polymorphisms and treatment-resistant depression. Progress in neuropsychopharmacology and biological psychiatry 2010; 34: 934-9. http://dx.doi.org/10.1016/j.pnpbp.2010.04.020