Electroconvulsive therapy in a 91-year old Asian lady with late onset bipolar mania

Electroconvulsive therapy (ECT) is safe and efficacious in the elderly population. However, clinicians are still weary to use it among the old-old population, citing safety concerns. Our case report highlights the use of ECT in a 91 year old lady with late onset Bipolar Mania.

A 91 year old lady presented with an acute manic relapse for the past 2 weeks. She was previously on oral Sodium Valproate, and during this current admission was augmented with oral Quetiapine IR 100 mg bd. She remained unwell and was planned for right unilateral ECT with age-based dosing stimuli. After only 4 sessions, she showed complete resolution of her manic symptoms.

In our case study, the patient showed rapid response to right unilateral ECT. Even though the Post Suppression Index (PSI) was not significant, there is some evidence that in elderly patients, burst suppression (not measured in this case) may be more accurate measure of ECT efficacy. The transient treatment emergent delirium was short lived and ECT was very tolerated in this patient.

Clinicians should not delay ECT in old-old patients who do not respond to pharmacologic treatment, as early switch to ECT results in rapid response with good safety profile.