Abstract
To the Editor
Some patients require ongoing electroconvulsive therapy (ECT) following an acute course of ECT to prevent relapse. These patients are often refractory to, or do not tolerate, pharmacotherapy and have historically responded well to ECT (Petrides et al., 2011). Melbourne entered into strict community restrictions in mid-2020 to control the spread of COVID-19. This resulted in guidelines for managing aerosol generating procedures (AGPs) including ECT, balancing safety for consumers and healthcare workers with continuation of treatment. We report a new ECT protocol that facilitated clinical recovery in a patient having maintenance ECT.
A 73-year-old married woman with a 40-year history of schizoaffective disorder, stable for many years on trifluoperazine, experienced a relapse with depressive and psychotic symptoms in 2018, following the unavailability of this medication. Following poor responses to two atypical antipsychotics, mirtazapine and tricyclic antidepressants she commenced bitemporal, brief pulse ECT (BT ECT). She achieved clinical remission with 10 ECTs. She was stable for around 12 months, but she then had a series of admissions, each episode responding well to acute courses of BT ECTs. Unfortunately the interval between admissions gradually shortened. Continuation ECT was discussed; however, due to the active COVID-19 restrictions on AGPs, it was decided that this would be too risky, particularly for elderly patients.
On this background, a new ECT protocol was developed to balance COVID-19 safety aspects and treatment needs. This ‘burst’ protocol comprised week-long planned admissions during which the patient was tested for COVID-19 and then isolated until ECT was provided on Wednesday and Friday of the week, followed by a 2- to 3-week ECT-free period in the community. With this protocol, this patient’s mental state remained stable in the next 3 months.
Safe provision of ECT during the pandemic is a challenge (Sienaert et al., 2020). This new ECT protocol can help to sustain ECTs for patients who need maintenance ECTs (mECTs) ECTs (mECTs) during community restrictions. It may also be relevant to patients living in remote areas with limited access to outpatient ECTs. It is also possible that episodic courses of ECT followed by a longer ECT-free period may reduce cognitive burden in elderly patients.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
