ECT For Depression Comorbid With Anorexia Nervosa: Case Report and Literature Review in Dutch
Out on PubMed, from investigators in Belgium, is this paper:
The abstract is copied below:
Background: Often anorexia nervosa occurs with other psychiatric comorbidities of which mood disorders are the most frequent. Depressive feelings hamper the chance of a favourable outcome of this persistent disorder. In addition, the underweight makes antidepressants work suboptimal. Electroconvulsive therapy (ECT) offers an important therapeutic value in the treatment of mood disorders. We are investigating whether ECT can be an effective treatment method for patients with anorexia nervosa and major depressive disorder.
Aim: Analysis of the literature on the possible effectiveness of electroconvulsive therapy (ECT) in the treatment of major depressive disorder and anorexia nervosa supplemented with a case report.
Method: Literature study in PubMed, Web of Science and Embase and a case report.
Results: 262 published articles were found between 1955 and 2020, 16 were found to be relevant.
Conclusion: From the literature, clinical recommendations cannot be made binding. No randomized controlled trials have been published on this subject. However, we saw in our case study and in the literature found that clearing the depressive symptoms through electroconvulsive therapy led to an improvement in food and fluid intake. ECT has no effect on their deranged thought pattern.
In the treatment of AN, the diet should be repaired in the first place. After recovery from body weight, antidepressants can be used to treat depressive symptoms. In case of a serious major depressive disorder (MADRS score > 19) the treatment of AN can be severely hampered and not recover weight. Malnutrition and depressive symptoms presumably have a synergistic effect on each other (Mattar et al. 2011). ECT is a fast-acting and safe treatment for depressive episodes, possibly also for patients with AN and severe comorbid depression, where the regular treatment for the eating disorder is not working (Ferguson et al. 1999). Reducing the has depressive symptoms in the literature found a positive effect on the intake of fluids and food, but the anorectic cognitions and body image distortions remain undisturbed. However, we think that by improving mood, motivation, diet and weight, may well create new opportunities for impaired cognitions through behavioral therapy interventions. This requires a multidisciplinary approach, with a combination of medical care, ECT and psychotherapy in the treatment of AN with severe, comorbid depression .
[Electroconvulsive therapy in the treatment of depression in anorexia nervosa].
Tijdschr Psychiatr. 2021;63(9):673-678.PMID: 34647306 Dutch.
Background: Often anorexia nervosa occurs with other psychiatric comorbidities of which mood disorders are the most frequent. Depressive feelings hamper the chance of a favourable outcome of this persistent disorder. In addition, the underweight makes antidepressants work suboptimal. Electroconvulsive therapy (ECT) offers an important therapeutic value in the treatment of mood disorders. We are investigating whether ECT can be an effective treatment method for patients with anorexia nervosa and major depressive disorder.
Aim: Analysis of the literature on the possible effectiveness of electroconvulsive therapy (ECT) in the treatment of major depressive disorder and anorexia nervosa supplemented with a case report.
Method: Literature study in PubMed, Web of Science and Embase and a case report.
Results: 262 published articles were found between 1955 and 2020, 16 were found to be relevant.
Conclusion: From the literature, clinical recommendations cannot be made binding. No randomized controlled trials have been published on this subject. However, we saw in our case study and in the literature found that clearing the depressive symptoms through electroconvulsive therapy led to an improvement in food and fluid intake. ECT has no effect on their deranged thought pattern.
And from the text: (translated by Google, then edited by me):
Conclusions
In the treatment of AN, the diet should be repaired in the first place. After recovery from body weight, antidepressants can be used to treat depressive symptoms. In case of a serious major depressive disorder (MADRS score > 19) the treatment of AN can be severely hampered and not recover weight. Malnutrition and depressive symptoms presumably have a synergistic effect on each other (Mattar et al. 2011). ECT is a fast-acting and safe treatment for depressive episodes, possibly also for patients with AN and severe comorbid depression, where the regular treatment for the eating disorder is not working (Ferguson et al. 1999). Reducing the has depressive symptoms in the literature found a positive effect on the intake of fluids and food, but the anorectic cognitions and body image distortions remain undisturbed. However, we think that by improving mood, motivation, diet and weight, may well create new opportunities for impaired cognitions through behavioral therapy interventions. This requires a multidisciplinary approach, with a combination of medical care, ECT and psychotherapy in the treatment of AN with severe, comorbid depression .
This is a welcome scholarly review on an important topic. Perhaps it will be fully translated from the Dutch soon.The treatment with ECT of severely depressed patients (mostly females) with AN has a long clinical history and this modest-sized evidence base. Certainly most senior clinicians will be able to relate their gratifying experiences of treating such patients with, at times, life-saving results.
Thanks to our Belgian colleagues for spotlighting this uncommon, but important, indication for ECT.
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