ECT for OCD: Case Report

Out on PubMed, in JECT, from clinicians in Portugal, is this case report:

Electroconvulsive Therapy in Refractory Obsessive-Compulsive Disorder: A Case Report.

Martins-Correia J, Rodrigues-Silva N, Nunes S.J ECT. 2020 Nov 9. doi: 10.1097/YCT.0000000000000731. Online ahead of print.PMID: 33181561

The abstract is copied below:

Electroconvulsive therapy (ECT) is a treatment of undisputed efficacy for severe and treatment-resistant psychiatric disorders. Notwithstanding extensive data on efficacy and safety, it is significantly underused, corresponding to one of the most stigmatized approaches in psychiatry. The list of problems for which ECT is potentially effective does not include obsessive-compulsive disorder (OCD), resulting in only a few available case reports in the literature in which OCD is the target of this specific therapeutic strategy. The authors describe a patient with refractory OCD for whom ECT was prescribed, with remarkable clinical response and functional improvement. The existence of a clear response to ECT in reported cases of OCD, albeit in a globally small number of patients, should make it essential to identify predictors of ECT response that could assist clinicians in assessing and guiding such cases, particularly those labeled as refractory to treatment.

And from the text:

[In this patient] remission was achieved for obsessive-compulsive symptoms as well as marked improvement of general psychopathology, using a low side effect ECT protocol (unilateral electrode placement and ultrabrief pulses), which was in fact very well tolerated by the patient. 

This case report is a useful reminder that ECT is sometimes very helpful for OCD. The literature on ECT for OCD is of moderate size; it suggests that the response of OCD to ECT is much less predictable than for depression, but that enough patients experience substantial clinical improvement to make ECT a treatment option in refractory cases. I have long believed that in severely ill patients with OCD for whom a neurosurgical procedure is being considered, a course of ECT should definitely be tried first.

This case is interesting because of the reported efficacy of RUL-UBP ECT (course of 10 treatments), with remission sustained for 9 months on lithium and sertraline, but no maintenance ECT.