A retrospective case series of electroconvulsive therapy in the management of comorbid depression and anorexia nervosa

Abstract

Objective Major depressive disorder (MDD) is common in anorexia nervosa (AN), associated with worse outcome and greater suicide risk. Electroconvulsive therapy (ECT) is highly effective in the treatment of MDD refractory to antidepressive treatment. We describe a case series of female adolescents with AN receiving ECT for MDD resistant to treatment and/or with severe suicide risk. Method We retrospectively analyzed the files of all 30 adolescent females hospitalized in our department because of AN between 1998 and 2017 and treated with ECT. Severity of eating disorder (ED) and depressive symptoms was retrospectively assessed using the Clinical Global Impression‐Severity Scale. Results Patients were severely depressed and suicidal on admission. All were resistant to antidepressants. A significant deterioration in depression, with severe suicidality, occurred from admission to pre‐ECT, with concomitant improvement in ED symptoms and increase in body mass index (BMI). Significant improvement in depressive and ED symptoms and increase in BMI occurred following ECT, continuing to discharge. Adverse effects were mostly minimal. Fifty‐three percentage of the patients were rehospitalized within the first year after ECT, mostly because of deterioration of depression and attempted suicide. Several years after discharge, 46.6% of the patients had no evidence of depression, suicidality, and ED‐symptomatology, and another 23% had only evidence of ED symptomatology. Discussion ECT is safe and well tolerated in AN with severe comorbid treatment resistant MDD and/or with increased suicide risk. Many AN patients undergoing ECT may be remitted at long‐term follow‐up.

A Systematic Review of Neuromodulation Treatment Effects on Suicidality

“…There was one case series that included adolescent patients. In a case series of 30 female adolescent patients with anorexia nervosa who were hospitalized and treated with ECT due to severe suicidal risk (severe suicidal ideation or suicide attempt), only one patient attempted suicide during ECT treatment, and no patients completed suicide following ECT treatment (Shilton et al, 2020). Depression severity also significantly decreased after ECT treatment (vs. before ECT).…”

Brain Stimulation in Eating Disorders: State of the Art and Future Perspectives

“…Indeed, due to the high suicide rate in patients with EDs, intensive treatments, like ECT, are often proposed. The recent and largest case series on patients with AN treated by ECT concerned 30 adolescents with comorbid depression [62]. All were severely depressed and suicidal upon admission and resistant to antidepressants.…”

“…In their study targeting two areas in the same trial for the first time, the targets were chosen based on two of the major psychiatric comorbidities associated with AN: SCC for affective disorder (n = 4) and NAcc for anxiety disorder (n = 4) [102]. Indeed, most studies reported positive effects on depressive symptoms with rTMS [26], tDCS [56], ECT [62], and DBS [93]. Future studies in EDs might benefit from this knowledge in brain target selection (Figure 1), in studies design (add-on with another modalities of treatment, inclusion and exclusion criteria, etc.…”

Neurostimulation Approaches in the Treatment of Severe Anorexia Nervosa

“…A more recent review examined the data of adolescent case files (between 1998 and 2017) from an Israel medical center [55]. Of 667 patients hospitalized over the period due to severe AN, 4.5% of the patients (n = 30) received ECT.…”