Electroconvulsive Therapy in Cochlear Implant Users

Cochlear implant manufacturers currently contraindicate the use of electroconvulsive therapy (ECT) in CI users, citing theoretical evidence of potential harm to the patient or the implant despite a lack of clinical data. We report two uncomplicated cases of ECT in CI users, including the first reported case of bilateral ECT in a patient with bilateral CIs.

The first case involves a 66-year-old visually impaired male with bilateral CIs. He suffered from major depressive disorder complicated by refusal of oral intake despite maximal pharmacological therapy. He underwent 9 consecutive cycles of bilateral ECT, after which his psychiatric condition improved. Cochlear implant function remained unchanged following the procedure. The second case involved a 65-year-old female with a left-sided CI and a history of recurrent depressive disorder. Her condition deteriorated with the onset of auditory hallucinations and increased suicidality. She underwent 8 consecutive cycles of unilateral ECT with right-sided electrode placement. Her psychiatric condition improved, and there was no change in CI impedance following the procedure.

We report 2 successful cases of ECT in CI users, including the first reported case of bilateral ECT in a patient with bilateral cochlear implants. Further investigation into the safety of ECT in CI users is warranted to ensure that this crucial treatment modality remains available to this vulnerable patient cohort.