Spontaneous seizures after ECT in a patient medicated with bupropion, sertraline and risperidone

Abstract Objective: To report a case of post-electroconvulsive therapy spontaneous seizures in a patient medicated with sertraline, bupropion and risperidone. Case description: A 53-year-old woman with recurrent major depression was admitted to our psychiatry department for a major depressive episode of 6 weeks' duration, with psychotic symptoms. She was already on 200 mg/day of sertraline and 2 mg/day of risperidone. After 8 weeks on 200 mg/day of sertraline, 4 mg/day of risperidone and slow release bupropion (titrated to 300 mg/day), with no objective improvements, the decision was taken to initiate a course of 8-10 electroconvulsive therapy (ECT) sessions. Two days after the first treatment, three generalized tonic-clonic seizures occurred within 6 hours. Phenytoin and sodium valproate were added to the patient's daily medication and no further spontaneous seizures were observed. After neurologic assessment and discussion of the case, phenytoin and bupropion were withdrawn at once (two days after the spontaneous seizures) and the decision was taken to resume the ECT treatment. No further spontaneous seizures occurred and, at discharge, the patient exhibited significant improvements and was free from major depressive symptoms. Comments: This report illustrates a case of post-ECT spontaneous seizures that might have been due to a specific pharmacological etiological pathway, namely, bupropion's proconvulsive properties, although both sertraline and risperidone also lower the convulsive threshold.

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A Comparison Of The Improving In Major Depressive Symptoms As Reported By Romanian Physicians And Patients In a Prospective, Multicenter, Observational Study

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1522 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S442-S442

Author(s):

T. Purnichi ◽

V. Marinescu ◽

M. Ladea ◽

M.C. Eda ◽

I. Marinescu ◽

...

Keyword(s):

Observational Study ◽

Major Depressive Episode ◽

Clinical Status ◽

Response To Treatment ◽

Major Depressive ◽

Multicenter Observational Study ◽

The Difference ◽

Competing Interest ◽

Major Depressive Symptoms ◽

Prospective Multicenter Observational Study

IntroductionDepression leads to substantial suffering for the patients, their families and becomes an economic burden for system [1,2]. Patients and clinicians tend to rate the remission differently [3].Objectives and methodsWe investigate if clinicians and patients rate different the treatment response. This study assed the evolution of major depressive episode (MDE) in patients treated with Agomelatine, in Romania. It was designed as a multicentre, observational study that included 1213 adult patients evaluated in 75 sites in 2014. The design included 3 visits (baseline (V1); visit at 2/3 weeks (V2); visit 6/8 weeks (V3)). The scales used were: MADRS, SHAPS, CGI-I, CGI-S, PGI-I, PGI-S.ResultsThe MDE improvement was significant (P < 0.001) for all aspects evaluated. At baseline, more clinicians vs. patients considered the moderately or markedly ill as best descriptors of the state. The difference between the two assessments was even higher for V2 and V3. During V2 clinicians reported “minimally improvement” while patients reported “much improvement” in higher percentage. During V3, both, clinicians and patients reported a “very much improved” clinical status. Of the patients 42.60% reported at V3 “normal”, not at all ill’ in comparison to 34.81% of clinicians who reported the same (P < 0.001).ConclusionsThis could mean that patients are not aware of the severity of their disease. This data could be interpreted in the way that patients are more prone to rate higher the improvements as response to treatment and the clinicians to rate as response a more than 50% decrease of symptomatology.References not available.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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The benefits and costs of changing treatment technique in electroconvulsive therapy due to insufficient improvement of a major depressive episode

Brain Stimulation ◽

10.1016/j.brs.2020.06.016 ◽

2020 ◽

Vol 13 (5) ◽

pp. 1284-1295

Author(s):

Harold A. Sackeim ◽

Joan Prudic ◽

D.P. Devanand ◽

Mitchell S. Nobler ◽

Roger F. Haskett ◽

...

Keyword(s):

Electroconvulsive Therapy ◽

Depressive Episode ◽

Major Depressive Episode ◽

Treatment Technique ◽

Major Depressive ◽

Benefits And Costs

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Complete Normalization of Severe Brain 18F-FDG Hypometabolism Following Electroconvulsive Therapy in a Major Depressive Episode

Clinical Nuclear Medicine ◽

10.1097/rlu.0b013e31829b9bd9 ◽

2013 ◽

Vol 38 (9) ◽

pp. 735-736 ◽

Cited By ~ 5

Author(s):

Cédrik Lajoie ◽

Marc-André Levasseur ◽

Nancy Paquet

Keyword(s):

Electroconvulsive Therapy ◽

Depressive Episode ◽

Major Depressive Episode ◽

Major Depressive ◽

18F Fdg

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Uses of Electroconvulsive Therapy in Conditions Other than Major Depressive Episode

Psychiatric Annals ◽

10.3928/00485713-20190314-02 ◽

2019 ◽

Vol 49 (4) ◽

pp. 157-163 ◽

Cited By ~ 1

Author(s):

Sandarsh Surya ◽

Ram Bishnoi ◽

Peter B. Rosenquist ◽

William V. McCall

Keyword(s):

Electroconvulsive Therapy ◽

Depressive Episode ◽

Major Depressive Episode ◽

Major Depressive

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Place of electroconvulsive therapy in the treatment of depression in France: A comparative study between clinical practice and international recommendations

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1446 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S767-S768

Author(s):

T. Charpeaud ◽

A. Tremey ◽

P. Courtet ◽

B. Aouizerate ◽

P.M. Llorca

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Electroconvulsive Therapy ◽

Bipolar Depression ◽

Psychotic Symptoms ◽

Diagnosis Delay ◽

Recurrent Depression ◽

University Hospitals ◽

Major Depressive ◽

Competing Interest

ObjectivesTo study the place of electroconvulsive therapy (ECT) in the treatment of major depressive disorder in France and compare it with international recommendations and algorithms.MethodMulticenter, retrospective study in 12 French university hospitals. Diagnosis, delay between the onset of the episode and the first day of ECT, previous treatments have been identified. Only patients treated for major depressive disorder between 1 January 2009 and 1 January 2014 were included.ResultsA total of 754 patients were included (middle age 61.07 years, sex ratio 0.53). The diagnoses listed were: first major depressive episode (14.95%), bipolar depression (38.85%) and unipolar recurrent depression (46.19%). The delay before ECT, was 11.01 months (13,98), and was significantly longer for first episodes (16.45 months, P < 0.001) and shorter in case of psychotic symptoms (8.76 months, P < 0.03) and catatonic symptoms (6.70, P < 0.01).ConclusionsThe delay before ECT appears on average, four times longer than recommended by treatment algorithms for the management of major depressive disorder. This long delay could be explained by a very heterogeneous access to this treatment in French territory.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Nonconvulsive Generalised Status Epilepticus Following Electroconvulsive Therapy

Australian & New Zealand Journal of Psychiatry ◽

10.1080/j.1440-1614.2000.00713.x ◽

2000 ◽

Vol 34 (2) ◽

pp. 334-336 ◽

Cited By ~ 7

Author(s):

Alexander Srzich ◽

John Turbott

Keyword(s):

Differential Diagnosis ◽

Status Epilepticus ◽

Electroconvulsive Therapy ◽

Mental State ◽

Clinical Picture ◽

Major Depressive Episode ◽

Major Depressive ◽

Intravenous Diazepam ◽

Confusional States ◽

Electroencephalogram Eeg

Objective: To describe a case of nonconvulsive generalised status epilepticus (NGS) following electroconvulsive therapy (ECT). Clinical picture: A 40-year-old woman suffering from a major depressive episode was treated with ECT following treatment with clonazepam, haloperidol and paroxetine. After her fifth treatment she became acutely confused. An electroencephalogram (EEG) at the time was consistent with NGS. Treatment and outcome: Initially intravenous diazepam and phenytoin were administered with an improvement in both her mental state and EEG. An oral anti-convulsant was continued. Conclusions: NGS is a rare though treatable cause of confusional states following ECT and should be considered in the differential diagnosis.

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P-1-11 Evolution of platelet and plasma serotonin levels following electroconvulsive therapy in patients with major depressive episode

European Neuropsychopharmacology ◽

10.1016/0924-977x(95)90347-g ◽

1995 ◽

Vol 5 (3) ◽

pp. 268

Author(s):

P. Quintin ◽

O. Spreux-Varoquaux ◽

K. Kodenbacn ◽

A. Gregoire ◽

C. Adverier ◽

...

Keyword(s):

Electroconvulsive Therapy ◽

Depressive Episode ◽

Major Depressive Episode ◽

Major Depressive ◽

Plasma Serotonin

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Early and late effects of electroconvulsive therapy associated with different temporal lobe structures

Translational Psychiatry ◽

10.1038/s41398-020-01025-8 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Shimpei Yamasaki ◽

Toshihiko Aso ◽

Jun Miyata ◽

Genichi Sugihara ◽

Masaaki Hazama ◽

...

Keyword(s):

Temporal Lobe ◽

Electroconvulsive Therapy ◽

Gray Matter Volume ◽

Psychotic Symptoms ◽

Therapeutic Effects ◽

Voxel Based Morphometry ◽

Major Depressive ◽

Antidepressant Effects ◽

Left Hippocampus ◽

Psychotic Features

Abstract Recent studies examining electroconvulsive therapy (ECT) have reported that early sessions can induce rapid antidepressant and antipsychotic effects, and the early termination of ECT was reported to increase the risk of relapse. We hypothesized that different neural mechanisms associated with the therapeutic effects of ECT may be involved in the different responses observed during the early and late periods of ECT treatment. We investigated whether these antidepressant and antipsychotic effects were associated with temporally and spatially different regional gray matter volume (GMV) changes during ECT. Fourteen patients with major depressive disorder, with or without psychotic features, underwent 3-Tesla structural magnetic resonance imaging scans before (time point [Tp] 1), after the fifth or sixth ECT session (Tp2), and after ECT completion (Tp3). We investigated the regions in which GMV changed between Tp1 and Tp2, Tp2 and Tp3, and Tp1 and Tp3 using voxel-based morphometry. In addition, we investigated the association between regional GMV changes and improvement in depressive or psychotic symptoms. GMV increase in the left superior and inferior temporal gyrus during Tp1–Tp2 was associated with improvement in psychotic symptoms (P < 0.025). GMV increase in the left hippocampus was associated with improvement of depressive symptoms in Tp2–Tp3 (P < 0.05). Our findings suggest that different temporal lobe structures are associated with early antipsychotic and late antidepressant effects of ECT.

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Characteristics Associated with Depression Severity in 270 Juveniles in a Major Depressive Episode

Brain Sciences ◽

10.3390/brainsci11040440 ◽

2021 ◽

Vol 11 (4) ◽

pp. 440

Author(s):

Giulia Serra ◽

Maria Elena Iannoni ◽

Monia Trasolini ◽

Gino Maglio ◽

Camilla Frattini ◽

...

Keyword(s):

Depressive Episode ◽

Major Depressive Episode ◽

Rating Scale ◽

Severe Depression ◽

Psychotic Symptoms ◽

Depression Severity ◽

Suicidal Risk ◽

Major Depressive ◽

Mood Lability ◽

Linear Regression Modeling

Introduction: Severe depression is prevalent in young persons and can lead to disability and elevated suicidal risk. Objectives: To identify clinical and demographic factors associated with the severity of depression in juveniles diagnosed with a major mood disorder, as a contribution to improving clinical treatment and reducing risk of suicide. Methods: We analyzed factors associated with depression severity in 270 juveniles (aged 6–18 years) in a major depressive episode, evaluated and treated at the Bambino Gesù Children’s Hospital of Rome. Depressive symptoms were rated with the revised Children’s Depression Rating Scale (CDRS-R) and manic symptoms with the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) Mania Rating Scale (K-SADS-MRS). Bivariate comparisons were followed by multivariable linear regression modeling. Results: Depression severity was greater among females than males (55.0 vs. 47.2), with the diagnosis of a major depressive disorder (MDD) vs. bipolar disorder (BD; 53.8 vs. 49.3), and tended to increase with age (slope = 1.14). Some symptoms typical of mania were associated with greater depression severity, including mood lability, hallucinations, delusions, and irritability, whereas less likely symptoms were hyperactivity, pressured speech, grandiosity, high energy, and distractibility. Factors independently and significantly associated with greater depression severity in multivariable linear regression modeling were: MDD vs. BD diagnosis, female sex, higher anxiety ratings, mood lability, and irritability. Conclusions: Severe depression was significantly associated with female sex, the presence of some manic or psychotic symptoms, and with apparent unipolar MDD. Manic/psychotic symptoms should be assessed carefully when evaluating a juvenile depressive episode and considered in treatment planning in an effort to balance risks of antidepressants and the potential value of mood-stabilizing and antimanic agents to decrease the severity of acute episodes and reduce suicidal risk.

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