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Safety and Effectiveness of Electroconvulsive Therapy in Anorexia Nervosa and Depression – A Case Report

Author(s): Smallenburg L C S, Van der Heijden C L L, Schaapherder J M, Wagemaker F, Mihaescu R, Bogers J P A M

Background: Anorexia nervosa (AN) mainly affects adolescents and young adults. AN is highly associated with comorbid psychiatric disorders such as depresssion, which makes treatment difficult. Pharmacological options are limited because selective serotonin re-uptake inhibitors (SSRIs) are less effective in underweight individuals. Electroconvulsive therapy (ECT) is an important treatment option for depression, but is rarely considered in patients with AN. Clinicians wary of using ECT for treating patients with AN, because they question whether it is safe and effective in these patients. Is this caution justified?

Case presentation: We describe a 21-year-old woman with restrictive AN and depression, with suicidality. Trials of psychotherapy for depression and various antidepressants were unsuccessful and her condition deteriorated. She was admitted to hospital several times because of the precarious state of her health due to the eating disorder and serious suicide attempts. ECT was started because of the severe suicidality and her restrictive eating pattern. There were no complications, and the eating disorder and depression improved relatively soon after the start of treatment. ECT provided a breakthrough in the treatment of an unresponsive, life-threatening situation, such that follow-up therapy could be started. The eating disorder regressed several months after ECT.

Conclusions: Case reports have their limitations and there is no unequivocal evidence that ECT is effective for AN with comorbid depression. Yet the literature suggests that ECT should be considered in a life-threatening situation or when treatment possibilities are exhausted. AN and underweight are not contraindications for ECT, although medical screening before treatment is highly recommended. The long-term effectiveness of ECT has yet to be established.

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