scholarly journals Worsening of movement disorder following treatment with electroconvulsive therapy in a patient with Huntington’s disease

2019 ◽  
Vol 12 (8) ◽  
pp. e230389 ◽  
Author(s):  
Hesitha Abeysundera ◽  
Allan Campbell ◽  
Shanthi Sarma
Keyword(s):  
Case Report ◽  
Huntington's Disease ◽  
Movement Disorder ◽  
Huntington’S Disease ◽  
Electroconvulsive Therapy ◽  
Movement Disorders ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Medical Practitioners ◽  
Resistant Depression

This paper describes a patient who presented with treatment-resistant depression with comorbid anxiety symptoms in the context of Huntington’s disease (HD) and developed worsening movement disorder symptoms after commencing electroconvulsive therapy (ECT) for depression. The aim of this case report is to provide medical practitioners with a greater awareness of the possibility of worsening movement disorders when using ECT for depression in a patient with HD.

Alternating intravenous racemic ketamine and electroconvulsive therapy in treatment resistant depression: A case report

2017 ◽  
Vol 41 (S1) ◽  
pp. S522-S522
Author(s):  
L. Bartova ◽  
A. Weidenauer ◽  
M. Dold ◽  
A. Naderi-Heiden ◽  
S. Kasper ◽  
...  
Keyword(s):  
Case Report ◽  
Electroconvulsive Therapy ◽  
Antidepressant Treatment ◽  
Psychiatric Inpatient ◽  
Treatment Strategies ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Before And After ◽  
Racemic Ketamine ◽  
Resistant Depression

IntroductionTreatment resistant depression (TRD) affecting approximately 10–30% of all depressed patients often remains misdiagnosed and undertreated, leading to a higher risk of relapse and suicide. Electroconvulsive therapy (ECT) and sub-anesthetic ketamine have repeatedly shown to be effective in the TRD population. Administering ketamine as an anesthetic component to augment antidepressant efficacy of ECT has been proven inconclusive, while a combination of alternating ECT and ketamine has not been investigated yet.Case reportWe present a severely depressed and chronically suicidal female inpatient who failed multiple antidepressant treatment attempts, requiring frequent psychiatric admissions. Since available conventional as well as non-conventional antidepressant treatment strategies were nearly exhausted, we employed a combination of ECT (bilateral stimulation up to 150%) 2–3 times/week, while intravenous racemic ketamine (up to 75 mg per infusion) was administered on ECT free days 2–3 times/week. Consequently, robust anti-suicidal and antidepressant effects could be observed already during the first treatment week. The temporarily occurring subjective forgetfulness disappeared after the last ECT. Summarizing, we employed 9 ECT treatments and 7 ketamine infusions leading to a stable psychopathological state even after discharge from psychiatric inpatient care. In order to prevent relapse a maintenance-therapy comprising ECT once monthly and 2 ketamine infusions (up to 100 mg per infusion) administered on the day before and after ECT was established.ConclusionsIn our patient alternating ECT and intravenous racemic ketamine were proven safe and long-term effective after numerous failed antidepressant trials including ECT and ketamine alone. We may hence encourage clinicians to widen their therapeutic armamentarium in severe TRD.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Understanding Treatment-Resistant Depression: A Missionary’s Autobiographical Case Report

2019 ◽  
Vol 6 (1) ◽  
pp. 43-50
Author(s):  
Hunter York
Keyword(s):  
Case Report ◽  
Depression Symptoms ◽  
Primary Concern ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Spiritual Discipline ◽  
Convulsive Therapy ◽  
Service Oriented ◽  
Resistant Depression ◽  
Electro Convulsive Therapy

As a career cross-cultural missionary in Southeast Asia, the author has seen first-hand and has personally experienced the devastating effects of colleagues, families, leaders, clinicians, and the sufferers themselves misunderstanding the symptoms and the reality of major depressive disorder, an increasing global health problem.  This autobiographical case report reflects on twenty years of treatment-resistant depression and a journey through pharmacological approaches, psychotherapy treatment, Christian prayer counselling, and electro convulsive therapy without improvement in this condition.  The primary concern is how to remain faithful and effective with this condition in a service-oriented occupation that requires regular emotional expenditure.  In lieu of effective conventional and non-conventional therapies, the remaining option is to find a way to manage chronic depression; identify personal trends, weaknesses, and triggers; and find a personalized way to live that minimizes the effects of the condition.  In any chronic, incurable disorder, the sufferer must inevitably come to terms with his or her reality and find peace in the acceptance of that reality.  By expressing the journey through treatment-resistant depression, the author encourages readers to persevere in ministry and to respond more appropriately to the afflicted with clearer understanding and empathy.  A companion article on mitigating depression symptoms through the spiritual discipline of identifying with Christ and His experience of human emotional pain during His passion is available.  

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