Electroconvulsive Therapy in the Elderly

Patrick Bracken, Margaret Ryan, David Dunne
1987 British Journal of Psychiatry  
255â€"257) present the case of a 91-year-old patient who responded well to ED'. The oldest documented patient to receive ECT was a 94-year-old woman (Bernstein, 1972). We describe the successful use of ECT in a woman aged 103 years. Case Report: The patient, who was born on 6 December 1883, was referred to us by her GP with a history of worsen ing depression over the preceding weeks. On admission she appeared very depressed and expressed the idea that God no longerwantedher. Shefeltthat
more » ... iland that she belonged to the devil. She also said that she felt â€oe¿ dirty and rotten―inside. She was preoccupied with religious ideas and spoke of little else. Her family reported that her interest in outside events had diminished prior to admission and her appetite had deteriorated. She was diagnosed as suffering from a psychotic depression. She told us that her first episode of depression had been 40 years previously, when she lived in England. This had recurred from time to time over the years and her first admission to this hospital was in 1977. That episode was similar in its presentation to the current one. At that time she was treated with ECT but relapsed soon after. Altogether, in 1977she received three courses of ECT, each of approximately four treatments. There was no definite family history of affective illness. Physical examination during this recent admission revealed that she was suffering from mildcongestivecardiac failureand atrial fibrillation. She was receiving digoxin and frusemide for this. She was treated initially with a course of mianserin and later of doxepin. These produced no change, and after eight weeks of in-patient care she was still depressed and miserable. We discussed ECT with her and her family and she agreed to receive a course. The anaesthetist had some reservations, but in view of her persistent depression and previous response to ECT he agreed that it was an acceptable risk to give her a general anaesthetic. She received two treatments in all and was remarkably improved after the second. She was somewhat confused after the treatment, but this dis appeared within 24 hours. As she was by now well, it was decided not to proceed to a full course of ECT. It is now two months since the patient's discharge and she remains well. We think that this report demonstrates the effec tiveness of ECT as a treatment for psychotic depression even in theveryelderly age-group. We agree with Weiner(l982) that ECT is a re'atively safe treatment in the elderly if performed with due precautions.
doi:10.1192/bjp.150.5.713a pmid:3651713 fatcat:z635yt5orja3nkaihrevcoilc4