Key result
Electroconvulsive therapy was safely administered and well tolerated in a 96-year-old woman with severe aortic stenosis, resulting in a full remission of her severe depression.
Why the study?
Does electroconvulsive therapy (ECT) safely improve severe depression in a 96-year-old patient with severe aortic stenosis?
Case Report (n=1)
Does electroconvulsive therapy (ECT) safely improve severe depression in a 96-year-old patient with severe aortic stenosis?
This case demonstrates that advanced age and severe aortic stenosis do not absolutely preclude the safe and effective use of electroconvulsive therapy for severe depression.
ECT may be feasible in select nonagenarians with severe aortic stenosis; leaves open generalizability pending larger studies.
We report the safe administration of a course of electroconvulsive therapy (ECT) in a 96-year-old woman with severe aortic stenosis. The patient experienced a relapse of her severe depression when ECT had been withheld because of increased concerns regarding medical risk given her age and degree of aortic stenosis. Reassessment of the case confirmed severe stenosis with a valve area of 0.5 cm2 and a peak pressure gradient across the valve of 110 mm Hg. The ventricular ejection was normal at 70% however, and after a careful weighing of the risk of ECT treatment versus the risk of withholding ECT, it was decided to proceed with ECT in this case. In the event, ECT was very well tolerated by the patient, and she experienced a full remission of symptoms. She continues to receive maintenance ECT successfully at a once-per-month frequency. This case illustrates that neither age nor aortic stenosis by itself precludes ECT in the setting of severe depression. Rather, in each case, a careful weighing of the risks both of proceeding with and withholding ECT is warranted.
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O’Reardon et al. (2008) conducted a case report in Severe depression and severe aortic stenosis (n=1). Electroconvulsive therapy (ECT) was evaluated on Tolerability and remission of symptoms. Electroconvulsive therapy was safely administered and well tolerated in a 96-year-old woman with severe aortic stenosis, resulting in a full remission of her severe depression.
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