Maintenance Electroconvulsive Therapy Meeting Unmet Needs of Antipsychotics in Older Patients: A Case Report

This case report highlights problems encountered by psychiatrists when treating a 68-year-old female patient who presented with a first episode of psychosis. She suffered from constipation, an anticholinergic side effect of quetiapine and both anticholinergic and extrapyramidal side effects of olanzapine. Finally, she was able to tolerate a combination of two pharmacologically different antipsychotics namely olanzapine and aripiprazole combined with a course of ECT followed by maintenance ECT. The authors would like to highlight maintenance ECT as part of the solution to patients who find it difficult to tolerate antipsychotics. Especially when only low doses of antipsychotics can be tolerated by the patient.

Amitriptyline in Depressive States

Amitriptyline, 5-(3 dimethylaminopropylidine)-dibenzo (a,d) (1,4) cycloheptadicne hydrochloride, though chemically and pharmacologically related to imipramine (Barsa and Saunders, 1961) has a tranquillizing effect which is absent with imipramine (Pressman and Weiss, 1961; Bennett, 1961); it acts simultaneously as an antidepressant through its influence on the “anxiety factor” (Freed, 1960; Dorfman, 1960). In contrast to imipramine and the monoamine oxidase inhibitors, amitriptyline has very little influence on the circulatory system and blood pressure (Jensen, 1961) and less proneness to exacerbate the symptoms of schizophrenia (Barsa and Saunders, 1961). Dunlop (1961) noticed a reduction in other symptoms, such as gastrointestinal distress, hyperventilation and vasomotor dysfunction for which amitriptyline was not primarily administered. This he attributed to an anticholinergic side-effect on the central nervous system.