Electroconvulsive therapy and subdural hemorrhage

Electroconvulsive therapy (ECT) was used to treat severe depressive illness in two patients, one of whom had undergone recent neurosurgery for subdura l hemorrhage (SDH) and another with a concurrent SDH in the absence of rais ed intracranial pressure. Although the second patient died 1 month after th e completion of ECT, in neither case did ECT extend the SDH or lead to othe r intracranial complications. It would seem that ECT can be performed safel y in the presence of SDH without mass effect or after surgical drainage of SDH, although clinicians should proceed cautiously in close collaboration w ith neurosurgical colleagues, review neuroimaging scans at regular interval s during and after the course of ECT, and use the dose-titration method of treatment with unilateral electrode placement away from the site of the les ion or surgery to minimize adverse effects.