Role of Electroconvulsive Therapy in Major Depressive Disorder with Borderline Personality Disorder: Case Report and Literature Review.

Major depressive disorder (MDD) becomes difficult to treat when the patient has a comorbid personality disorder. For such patients, even a combination of psychotherapy and pharmacotherapy has been ineffective. Electroconvulsive therapy (ECT) has been the first line of therapy for the treatment-resistant depression. We used this mode of therapy for a patient who had MDD along with borderline personality disorder and had failed trials of multiple medications and psychotherapy. ECT was very successful in our patient.

Prolonged Post-electroconvulsive Therapy Delirium: An Unusual Presentation.

Electroconvulsive therapy (ECT) is an effective but underutilized modality for the treatment of depression unresponsive to antidepressants. Mild to moderate cognitive impairment is a commonly encountered adverse effect but it normally resolves within hours. We report a case of post-ECT delirium lasting over a course of 14 days with succeeding sessions. Modification of ECT protocol by spacing the intervals of subsequent sessions and switching from bilateral brief pulse to unilateral ultra-brief pulse was found to be effective in reducing the confusion.

Carglumic Acid Treatment of a Patient with Recurrent Valproic Acid-induced Hyperammonemia: A Rare Case Report.

Valproic acid, first manufactured as an anticonvulsant, is commonly used to treat both neurological and psychiatric conditions. A rare and deadly side effect of this medication is hyperammonemia, presenting as lethargy, confusion, seizure, and, ultimately, coma. In rare circumstances, hyperammonemia can be recurrent and devastating, especially in patients with an underlying N-acetyl glutamate synthase (NAGS) deficiency, as the valproic acid can enhance this enzyme deficiency and inhibit the conversion of ammonia into urea in the liver. For these subtypes of patients, the United States Food and Drug Administration (US FDA) has recently approved carglumic acid, a medication that can act as a scavenger by effectively increasing the levels of NAGS, ultimately enhancing the conversion of ammonia to urea. In our case report, we have mentioned a patient with treatment-resistant bipolar disorder, who presented with elevated ammonia levels secondary to valproic acid treatment. Valproic acid was the only drug that was effective in his case, so we initiated therapy to reduce his elevated ammonia levels. After a thorough evaluation, we found the patient had a genetic NAGS deficiency. Carglumic acid was initiated and proved efficacious in our patient.