A Case Report of ECT and Muscle Spasms

Major depressive disorder, a psychiatric condition whereby individuals experience at least one major depressive episode, is a significant health concern in the United States, with the World Health Organization estimating an affected 16 million adults in 2012. Many individuals who seek professional help are successfully treated with pharmacology and/or psychotherapy. For the subset of patients who experience refractory depression, alternative pharmacological treatments are often tried. After a trial of antidepressant medication (lasting at least four weeks and after dose escalation if appropriate) recommendations include atypical antipsychotics, anticonvulsants, and lithium augmentation [1]. Lithium has long been known to be efficacious for the treatment of bipolar disorder, and studies have confirmed its role in unipolar depression, as well as highlighted its anti-suicidal properties [2]. If thorough pharmacological treatment remains ineffective in these patients, Electroconvulsive Therapy (ECT) may be recommended [2]. By nature of this stepwise treatment protocol, a significant number of individuals who require ECT are being prescribed other medications, including lithium. The literature regarding the use of lithium in conjunction with ECT has mixed results, and no clear consensus has been reached [3-5]. This report aims to briefly review the literature regarding lithium use during ECT treatment, as well as present a case of muscle spasms occurring in a patient after receiving short-term lithium treatment with other medications, and co-administered ECT.