Management of Depression in Patients with Severe Chronic Renal Disease with Electroconvulsive Therapy

It is often difficult to use antidepressants in patients with severe chronic renal disease. In such a scenario electroconvulsive therapy (ECT), is one of the treatment options. However, there is limited literature on the use of ECT in patients with severe renal impairment, currently receiving hemodialysis. To discuss the clinical presentation and management of two patients who presented with severe depression in the background of chronic kidney disease (CKD) (Grade V and Grade III respectively). Two elderly patients with CKD (Grade V and Grade III respectively) presented with severe depression, not responding adequately to the ongoing antidepressant medications. Both of them also had other comorbid physical illnesses that made management difficult. In view of the renal impairment, these patients were managed with ECT, with which both of them showed improvement. In fact, both of them were treated again with second course of ECT, when they experienced relapse of depression and both of them went on to receive continuation ECT. Both the patients continued to receive hemodialysis along with the ECT. ECT can be safely used in patients with CKD, who are currently receiving hemodialysis.