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Electroconvulsive Therapy for Refractory Anxiety and Depression in Superficial Siderosis: A Case Report

Gregory Pierpoint¹, Krishan Saini

¹Department of Psychiatry and Behavioral Sciences, Macon and Joan Brock Virginia Health Sciences, Eastern Virginia Medical School at Old Dominion University, Norfolk, VA.

Clinical Neuropharmacology

|November 14, 2025

Abstract

Objectives:

To report the first documented case of anxiety and depression related to superficial siderosis that responded to electroconvulsive therapy (ECT).

Methods:

A 58-year-old man with traumatic superficial siderosis presented with panic attacks and major depressive disorder unresponsive to multiple pharmacologic trials. Brain MRI revealed hemosiderin deposition in cerebellar-limbic structures. A course of bifrontal brief-pulse ECT (8 sessions) was administered.

Results:

After 8 sessions, the patient experienced full remission of panic attacks and functional recovery. The PHQ-9 score decreased from 21 to 7, and the GAD-7 score decreased from 19 to 6, with sustained improvement at the six-week follow-up.

Conclusions:

This case suggests that ECT can safely and effectively target cerebellar-limbic circuit dysfunction in superficial siderosis and supports further investigation into neuromodulation for refractory psychiatric symptoms in this population.

Keywords:

cerebellar anxiety cerebellar cognitive-affective syndrome electroconvulsive therapy hemosiderin deposition superficial siderosis

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