I used to have a postcard from Oxfam which said something along the lines of “I don’t know whether to be a shining example or a dreadful warning” and I am sometimes reminded of these words when reading “case reports” about people given electroconvulsive therapy (ECT).
The latest example comes from researchers at Toronto University in Canada and was published in BMJ Case reports in 2018: “Efficacy and safety of maintenance electroconvulsive therapy for sustaining resolution of severe aggression in a major neurocognitive disorder”.* Should we be reassured by the thought that there are “safe and effective” treatments out there or should we be… well… worried?
This case report is about a 64-year-old deaf man with dementia who was “admitted for acute behavioural disturbances and physical aggression.” During his stay in a “geriatric mental health inpatient unit” he was given two courses of 15 and nine ECT treatments (bilateral, mostly on maximum power of 576 mC) and maintenance ECT at weekly to monthly intervals. The monthly maintenance ECT treatments were continued after he was discharged back to a long-term care facility. The following drugs were also tried (not all at once): Quetiapine XR, Clonazepam, Haloperidol, Lorazepam, Olanzapine, Risperidone, Sertraline, Trazodone, Lurasidone, Loxapine, Melatonin, Quetiapine, Medroxyprogesterone.
The authors conclude: “The current case report supports employment of alternating acute and maintenance ECT trials to treat patients with MND [major neurocognitive disorder] with severe and refractory BPSD [behavioural and psychological symptoms of dementia].”
* Selvadurai MI, Waxman R, Ghaffar O, et al Efficacy and safety of maintenance electroconvulsive therapy for sustaining resolution of severe aggression in a major neurocognitive disorderCase Reports 2018; 2018:bcr-2017-222100.