Indian Journal of PsychiatryIndian Journal of Psychiatry
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CASE REPORT
Year : 2017  |  Volume : 59  |  Issue : 4  |  Page : 493-495

Electroconvulsive therapy for medication-refractory depression in a patient with ruptured intracranial dermoid cyst, meningioma, and neurofibromatosis


1 Department of Psychiatry, Masina Hospital, Mumbai, Maharashtra, India
2 Department of Psychiatry, LTM Medical College and Hospital, Mumbai, Maharashtra, India
3 Department of Psychiatry, Flynn Adult Inpatient Psychiatric Unit, La Trobe Regional Hospital, LRH Mental Health Services, Traralgon, Victoria, Australia
4 Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

Correspondence Address:
Dr. Chittaranjan Andrade
Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/psychiatry.IndianJPsychiatry_216_17

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Electroconvulsive therapy (ECT) is considered relatively contraindicated in patients with intracranial space-occupying lesions. A 53-year-old male presented with a 5-year history of medication-refractory major depressive disorder. Brain imaging findings suggested the presence of a ruptured dermoid cyst in the transverse sinus and a calcified meningioma in the temporal lobe sulcal space. There was no evidence of mass effect. Neurofibromatosis was the only other clinical condition present. The patient had no clinical neurological deficits. Since the depression was severe and he was suicidal, ECT was advised. There was a substantial improvement after four bilateral and then eight right unilateral brief-pulse ECTs administered on alternate days, thrice weekly. There were no complications associated with ECT. The treatment gains were maintained with maintenance antidepressant medication at a 1-year follow-up. This is probably the first reported case of the use of ECT in a medication-refractory, severely depressed patient with a ruptured intracranial dermoid cyst and with a calcifying meningioma. The results testify to the safety of ECT even in high-risk patients.



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