Download PDF
Pharmacopsychiatry 2017; 50(01): 41-42
DOI: 10.1055/s-0042-111519
Original Paper
© Georg Thieme Verlag KG Stuttgart · New York

Electroconvulsive Therapy Induces Transient Sensitivity for a Serotonin Syndrome: A Case Report

Michael Deuschle
1   Department of Psychiatry and Psychotherapy, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, University of Heidelberg
,
Andreas Böhringer
1   Department of Psychiatry and Psychotherapy, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, University of Heidelberg
,
Andreas Meyer-Lindenberg
1   Department of Psychiatry and Psychotherapy, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, University of Heidelberg
,
Alexander Sartorius
1   Department of Psychiatry and Psychotherapy, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, University of Heidelberg
› Author Affiliations
Further Information

Publication History

received 10 May 2016
revised 13 June 2016

accepted 25 June 2016

Publication Date:
26 July 2016 (online)

Also available at
    Permissions and Reprints

Abstract

Introduction: Serotonin syndrome is a potentially life-threatening condition with delirium, vegetative and neuromuscular symptoms as well as neural hyperexcitability. The main causes are combinations of serotonergic drugs, excessive dosages of serotonergic agents or the recreational use of certain drugs.

Methods and Results: We report a case of a patient who started developing serotonin syndrome after a cumulative dose of only 900 mg lithium carbonate given in temporal association with electroconvulsive therapy (ECT). The patient tolerated the serotonergic combination of escitalopram and lithium well a few weeks after ECT.

Discussion: Generally, hypersensitivity to psychotropic medications during a course of ECT is rare and hypothetically attributed to a possible and reversible alteration of the blood brain barrier. Consecutively, drugs with assumed central nervous side effects should be started at low dosages and slow titration within the first two days after ECT because even low plasma concentrations may not be tolerated. Importantly and as in other cases, the liability appeared to be of transient nature. In cases of non-tolerance immediately after ECT, a re-exposure after several weeks seems justified.

Key words

electroconvulsive therapy (ECT) - serotonin syndrome - selective serotonin reuptake inhibitors (SSRIs) - lithium
 

  • References

  • 1 Alusik S, Kalatova D, Paluch Z. Serotonin syndrome. Neuro Endocrinol Lett 2014; 35: 265-273
    PubMedGoogle Scholar
  • 2 Cipriani A, Hawton K, Stockton S et al. Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis. BMJ 2013; 346: f3646
    CrossrefPubMedGoogle Scholar
  • 3 Fink M. What was learned: studies by the consortium for research in ECT (CORE) 1997–2011. Acta Psychiatr Scand 2014; 129: 417-426
    CrossrefPubMedGoogle Scholar
  • 4 Cheng YC, Liang CM, Liu HC. Serotonin syndrome after electroconvulsive therapy in a patient on trazodone, bupropion, and quetiapine: a case report. Clin Neuropharmacol 2015; 38: 112-113
    PubMedGoogle Scholar
  • 5 Okamoto N, Sakamoto K, Yamada M. Transient serotonin syndrome by concurrent use of electroconvulsive therapy and selective serotonin reuptake inhibitor: a case report and review of the literature. Case Rep Psychiatry 2012; 2012: 215214
    PubMedGoogle Scholar
  • 6 Mandel MR, Madsen J, Miller AL et al. Intoxication associated with lithium and ECT. Am J Psychiatry 1980; 137: 1107-1109
    CrossrefPubMedGoogle Scholar
  • 7 Sartorius A, Wolf J, Henn FA. Lithium and ECT – concurrent use still demands attention: three case reports. World J Biol Psychiatry 2005; 6: 121-124
    CrossrefPubMedGoogle Scholar