Electroconvulsive Therapy in Severe Depressive Patients Following Implantation of Inferior Vena Cava Filter for Deep Venous Thrombosis

DOI 23 References
  • Kurimoto Naoki
    Department of Psychiatry, Shiga University of Medical Science
  • Fujii Yusuke
    Department of Psychiatry, Shiga University of Medical Science
  • Yamada Naoto
    Department of Psychiatry, Shiga University of Medical Science

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Other Title
  • 重症うつ病に併発した深部静脈血栓症に対し下大静脈フィルターを留置しmECTを施行した1例
  • ─深部静脈血栓，肺塞栓の予防，早期発見治療とrefeeding症候群から安全なmECTの導入に至るまで─

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[Background] Most cases of pulmonary embolism (PE) are caused by deep venous thrombosis (DVT). PE followed by electroconvulsive therapy (ECT) was reported by several researchers irrespective of the modality of ECT. We report a case of DVT where additional PE was prevented by implanting a retrievable inferior vena cava (IVC) filter combined with anticoagulant therapy during modified ECT (mECT), and we discuss the potential risks of DVT and PE. [Case] Over a period of 2 years, seven cases suffering from both DVT and PE were diagnosed at admission among severely depressed patients transferred from other hospitals. In four of these cases, to avoid additional PE and contamination, e.g., from aspiration pneumonia or ileus, we rapidly applied mECT and concomitantly implanted a retrievable IVC filter combined with anticoagulant therapy. A 73-year-old woman was admitted to the hospital in a depressive substupor state accompanied by dehydration and starvation, resulting from poor response to pharmacotherapy in a previous hospital. Immediately after diagnosing both DVT and PE, a retrievable IVC filter was implanted, and anticoagulants were concomitantly administered during six ECT sessions. [Conclusion] In order to perform ECT safely, prior checking for both PE and DVT is important, and implantation of a retrievable IVC filter is useful in such cases involving rapid induction of mECT.

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