Mood disorders Maintenance electroconvulsive therapy in a patient with Parkinson’s disease and comorbid bipolar disorder

Psychiatric symptoms in the Parkinson’s disease (PD) may occur as a direct result of the disease, as a comorbid disease or as side effects of medication. Euphoria can be seen in approximately 10% of patients treated with PD and mania may occur in 1% . Although the exact mechanism of action of Electroconvulsive therapy (ECT) has not been identified, it has been shown to be beneficial in PD with or without psychiatric symptoms . In this case, we aimed to present a patient with PD and comorbid bipolar disorder, who did not respond to medical treatment adequately and followed-up with maintenance ECT as treatment modality for 6 years. A 67-year-old male patient. He was admitted to our clinic with complaints of irritability, depressed mood, increased mobility, desire to spend a lot of money and decreased need for sleep, lasting for one month. The patient was hospitalized with a diagnosis of bipolar disorder with mixed episode. His Clinical Global Impression Severity (CGI-S) score was 6, Young Mania Rating Scale (YMRS) score was 28 and Hamilton Depression Scale (HAM-D) score was 21. Besides continuation and maintenance ECT for 5 years, he has been using valproate 1000 mg/day, quetiapine XR 300 mg/day, clonazepam 1 mg/day and his ECT were being applied once every two weeks. Because there were şuctuating amnesia for three months, his ECT was reduced from one session per week to one session per two weeks in the last 2 months. Patients and his relatives reported that his amnesia were improved but his irritability, low mood and lack of sleep complaints were increased after the frequency of ECT were decreased to once every two weeks. His ECT sessions were rearranged as once per week without any change in the doses of drugs. From the medical records of the patient it was learned that he has got PD since 2003. After eight sessions of ECT, patient’s complaints were improved and he was discharged with ECT to be administered once a week. His CGI-S score was 1, HAM-D score was 3 and PANSS score was 33. In this case, ECT was administered at different intervals for 6 years since 2007. Worsening of the patient’s mood and psychotic symptoms were detected when the intervals of ECT sessions increased. The patient did not adequately benefit from medical treatment. His well being was achieved with once a week ECT sessions. As a result, when the medical treatment of Parkinson’s disease with comorbid bipolar disorder is not beneficial enough, ECT should be considered as an alternative treatment. In this case, continuation and maintenance ECT administered successfully for Parkinson’s disease with comorbid bipolar disorder.