Lithium treatment for relapse prevention after electroconvulsive therapy in a patient with major depressive disorder and end stage renal disease

Mr. W., a 62-year-old man with recurrent major depressive episodes since the age of 20 years, has been receiving hemodialysis for 4 years because of end stage renal disease (ESRD). For more than 1 year he was suffering from a treatment resistant episode of major depression. Therefore, he finally was successfully treated with electroconvulsive therapy (ECT). ECT is highly effective for treatment of major depression but naturalistic studies show a high rate of relapse after discontinuation. Recently it was demonstrated that a combination of lithium and nortriptyline following ECT produced a substantially lower relapse rate than treatment with placebo (1). Thus, we decided to apply lithium to Mr. W. despite his ESDR. In collaboration with nephrologists 1600mg of lithium-acetate after each dialysis maintained predialysis levels at 0.8 mmol/l. This case report supports prior reports of successful and safe use of lithium in hemodialysis patients (2,3).

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Grüner et al. Pharmacopsychiat. 24 (1991) 13–16;

Quentzel et al. Psychosomatics 38 (1997) 398–99.