Catatonia an Unexpected Side Effect of Electroconvulsive Therapy: A Case Report

Catatonia is a neuropsychiatric syndrome characterized by motor and behavioral abnormalities, often associated with severe psychiatric or medical conditions. The use of electroconvulsive therapy (ECT) is a well-established treatment for catatonia; however, paradoxical onset during treatment is rare.

A 33-year-old woman with schizoaffective disorder, previously managed with antipsychotics, developed acute catatonia following the first ECT session. Her history included childhood epilepsy controlled with sodium valproate and long-term use of various antipsychotics, including clozapine. The patient developed stupor, mutism, and fixed staring immediately after ECT. All psychotropic medications were discontinued, and further ECT sessions were halted. The catatonia resolved within 24 h without further intervention. ECT was restarted after 7 days, leading to full remission after 15 sessions.

This case underscores the hypothesis of a rare paradoxical occurrence of catatonia induced by ECT, despite the absence of classic predisposing factors. The timing of catatonia suggests a potential interaction between ECT and other medications, particularly haloperidol, and the tapering of clozapine. This phenomenon warrants further investigation into the neurochemical mechanisms that might contribute to ECT-induced catatonia.

The occurrence of catatonia following ECT in this case underscores the need for careful monitoring, particularly in patients with complex psychiatric histories or any risk factor for catatonia. Although this phenomenon is rare, clinicians should be aware of the potential for catatonia to develop even in the absence of typical risk factors and take steps to manage it promptly.