neuroleptic sensitivity with a higher risk for neuroleptic malignant syndrome and extrapyramidal adverse effects. 1 Furthermore, studies on antidepressant use in patient with DLB found that selective serotonin reuptake inhibitors are not efficacious in the treatment of depressive symptoms in patients with DLB and may have adverse effects including the worsening of REM sleep behavior disorder symptoms. 2 As such, there is a significant need for nonpharmacologic management of depressive symptoms in patients with DLB.However, despite reassuring results from case reports, there are no randomized trials evaluating nonpharmacologic methods like ECT in DLB. In one small, uncontrolled study, all 7 enrolled patients had improvement in depressive symptoms with variable resolution of motor complaints, delusions, and hallucinations. 4 The longevity of improvement was also varied, with some patients achieving several months of depressive symptom resolution and others reporting only 2 weeks of relief. 4 A second study demonstrated that in 8 patients with DLB and an average HAM-D score of 38, there was a significant reduction in depressive symptoms after ECT. 5 The average posttreatment HAM-D score was 15, with no additional follow-up data presented. 5 Similarly, Mr A did not experience complete resolution of depression ECT, citing continued difficulties across domains such as psychomotor retardation. However, there was improvement in mood, suicidality, and agitation, the symptoms that most contributed to the acute need for hospitalization. As such, it is possible that ECT alleviated symptoms associated with the affective component of an MDE, but could not target neurovegetative symptoms chronically present in patients with DLB.In conclusion, the experience presented in this case, when considered alongside the existing data on ECT for DLB, provides a compelling argument for this treatment modality.