Successful electroconvulsive therapy in an elderly man with severe thrombocytopenia: case report and literature review

Electroconvulsive therapy (ECT) is a safe and effective treatment for depression. Furthermore, modifications to ECT have made it a safe procedure for patients who were previously thought to be too ill or old to undergo the stress of convulsions. Little is known, however, of the safety of performing ECT on patients with severe thrombocytopenia. Such patients may be at increased risk for hemorrhagic complications due to the procedure. In this article, we describe the case of a 74-year-old man with major depression and myelodysplastic syndrome with associated severe thrombocytopenia, who underwent successful administration of a full course (nine treatments) of ECT. The physiologic changes caused by modified ECT and the potential risk of hemorrhage (including intracranial hemorrhage) in thrombocytopenic patients undergoing ECT are also discussed.