Electroconvulsive Therapy: Other Disorders

Mental Disorders
There is a long history of ECT being used for the primary treatment of a variety of conditions other than major mood disorders and schizophrenia, including dysthymia, obsessive-compulsive disorder, eating disorders, anxiety disorders, and borderline personality disorder. In none of these disorders, however, is there compelling evidence for a true benefit, unless a major mood disorder or schizophrenia is also present (American Psychiatric Association Committee on ECT 2000). However, it is also sometimes the case that obsessive-compulsive, anxiety, hypochondriacal, and hysterical symptoms (as opposed to disorder) may occur de novo in episodes of major mood disorder or schizophrenia, and the practitioner should not be swayed against using an otherwise indicated treatment by the presence of such atypical features.

Neurological and Medical Conditions

ECT has been reported to produce improvement in affective and psychotic syndromes in patients with a variety of primary physical disorders, although the available data consist only of case reports and some retrospective series. ECT is not considered a first-choice treatment in such cases. This issue is particularly problematic with regard to patients who meet criteria for both major depression and dementia. In such cases the presence and degree of coexisting pseudodementia secondary to the mood disorder can be very difficult to evaluate, and it is best to go ahead and treat the “treatable” disorder. Specific antidelirium and anticatatonic effects have also been claimed for ECT in the context of neurological and medical conditions, although present use is primarily on a last-resort basis.

The powerful neurobiological changes associated with ECT can produce improvement in certain physical disorders, most notably Parkinson’s disease, neuroleptic malignant syndrome, hypopituitarism, and intractable seizure disorders (Krystal and Coffey 1997). Although in none of these disorders does it represent the first choice, ECT should be considered as a treatment alternative in otherwise resistant cases. The evidence for efficacy is most compelling in Parkinson’s disease, particularly when the “on-off” syndrome is present (Kellner et al. 1994). The relief in symptoms is, however, transient, lasting from weeks to months, although maintenance ECT may represent a means to consolidate these effects (Aarsland et al. 1997).

Chronic pain is a complex disorder in which the distinction between physical and mental components can often be extremely difficult to assess, particularly when there is coexisting major depression. This difficulty makes it hard to predict the effects of ECT on chronic pain, although the patient should be made aware that the treatment is being given for the mood disorder and that any improvement in the pain will likely be secondary to the improvement in the depressive symptoms. As such, there is no evidence that ECT is effective in the treatment of chronic pain when a major mood disorder is not present.