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Electroconvulsive therapy for Depression in Anorexia Nervosa. A review

Published online by Cambridge University Press:  01 September 2022

F. Azevedo*
Affiliation:
Centro Hospitalar de Lisboa Ocidental, Psychiatry, Lisbon, Portugal
R. André
Affiliation:
Centro Hospitalar Universitário Lisboa Norte, Psychiatry, Lisboa, Portugal
I. Donas-Boto
Affiliation:
Centro Hospitalar de Lisboa Ocidental, Psychiatry Department, Lisboa, Portugal
D. Jeremias
Affiliation:
Centro Hospitalar de Lisboa Ocidental, Psychiatry, Lisbon, Portugal
C. Almeida
Affiliation:
NOVA Medical School, Psychiatry And Mental Health, Lisboa, Portugal
*
*Corresponding author.

Abstract

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Introduction

Anorexia nervosa has an important burden on both patients and families, with important comorbidities such as depression and obsessive symptoms. These are more resistant to pharmacological treatment than in non-anorexia patients, due to both biological and psychological mechanisms. Electroconvulsive therapy is the best available therapy for treatment resistant depression making it a treatment to consider in treatment resistant depression in anorexia though only case reports exist.

Objectives

To review the current evidence for electroconvulsive therapy of depression in patients with anorexia nervosa as well as it’s ethical challenges

Methods

Non-systematic review of the literature with selection of scientific articles published in the past 10 years; by searching Pubmed and Medscape databases using the combination of MeSH descriptors. The following MeSH terms were used: “electroconvulsive therapy”, “anorexia nervosa”.

Results

Electroconvulsive therapy in anorexia has no controlled trials with mostly case reports available on scientific databases. It presents important challenges due to patient age, medical status and ethical challenges. Even less evidence exist for electroconvulsive therapy in children and adolescents than for adults, anorexia can complicate medical status presenting an anesthetic and life-support challenge and it’s egosyntonicity can place a legal and ethical challenge when patient refuses treatment.

Conclusions

Anorexia has a dramatic burden on patients and families affected, with integrated evidence-based treatment being necessary both for treating the current episode and for remission prevention. Case-reports show that electroconvulsive therapy can play a role on treatment resistant depression in anorexia.

Disclosure

No significant relationships.

Type
Abstract
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the European Psychiatric Association
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