ECT and lithium in old age depression - cause or treatment of rapid cycling?

ABSTRACT

OBJECTIVE: This article presents the case of an elderly woman experiencing a depressive phase of Bipolar Affective Disorder 1 (BPAD1), who required electroconvulsive therapy (ECT), prior to which her lithium was ceased, and who developed ultra-ultra-rapid cycling (UURC) and ultra-rapid cycling (URC). This resolved with the recommencement of lithium and continuation of ECT. METHOD: Case report and review of the relevant literature. RESULTS: The patient's mood stabilized with recommencement of lithium and continuation of ECT. CONCLUSIONS: Ceasing lithium prior to ECT may carry a risk of URC or UURC in BPAD1.