The role of electroconvulsive and neuromodulation therapies in the treatment of geriatric depression.

Objectives Patients with unrepaired abdominal aortic aneurysm (AAA) may have depression and other psychiatric disorders for which electroconvulsive therapy (ECT) may be recommended. It is unclear whether ECT, which transiently, yet markedly, increases blood pressure and heart rate, can be safely performed in patients with AAA. We investigated the safety of ECT in patients with unrepaired AAA. Methods A retrospective review was conducted of the medical records of all patients with unrepaired AAA who underwent ECT for severe depressive syndromes at Mayo Clinic, Rochester, Minn, between January 1, 1995, and June 30, 2007. Results Eight patients (5 men and 3 women) with unrepaired AAA who underwent ECT were identified. Median age was 78.5 years (range, 67-83 years). All patients had AAA (median diameter, 3.95 cm [range, 3.0-5.2 cm]). The median number of treatments was 8.5 (range, 4-48). None of the patients died during the periprocedural period or experienced symptoms or signs suggestive of AAA expansion or rupture. Follow-up imaging data were available for 6 patients whose median post-ECT AAA diameter was 4.65 cm (range, 3.3-5.3 cm). Expansion of AAA ranged from 0.1 cm (for 11 and 13 months in 2 patients) to 1.0 cm (for 29 months in 1 patient), which is less than the expected mean expansion rates for AAAs of these diameters. Conclusions Electroconvulsive therapy was safe for 8 patients with unrepaired AAA treated at our institution. Our findings may be informative to clinicians who manage the care of patients with unrepaired AAA who are undergoing ECT.

Safety of Electroconvulsive Therapy in Patients With Unrepaired Abdominal Aortic Aneurysm: Report of 8 Patients

Cardiovascular disease and ECT

This case report reviews the treatment of a 74-year-old man with an abdominal aortic aneurysm, bipolar affective disorder, and Lewy body dementia who demonstrated a remarkable positive response to an acute and maintenance course of electroconvulsive therapy (ECT) treatment. This is the first report with serial imaging of an abdominal aortic aneurysm during maintenance ECT. There are limited alternative therapies for those patients who do not meet surgical criteria for an abdominal aortic repair because of dementing disorders. In patients who suffer comorbid mood disorders, ECT has been shown to be an effective option in preserving quality of life and successfully stabilizing the level of agitation.

Triebel Wa

Papers

Electroshock therapy in presence of serious organic disease. Depression and aortic aneurysm.