SPECT findings before and after ECT in a patient with major depression and Cotard's syndrome

A patient's major depression and Cotard's syndrome (the delusion of being dead) both resolved completely after 12 ECT treatments. A SPECT study 1 week before ECT showed reduced blood flow in the frontoparietal medial and dorsolateral frontal cortex, basal ganglia, and thalamus; SPECT 1 month after ECT showed perfusion increments in those regions. This case study demonstrates that Cotard's syndrome in the context of major depression may be successfully treated with ECT and suggests that the psychiatric improvement was accompanied by increased blood flow in specific brain areas.