ECT in the presence of brain tumor and increased intracranial pressure: Evaluation and reduction of risk

The presence of brain tumor and increased intracranial pressure has long be en considered an absolute contraindication to electroconvulsive therapy. Re cently, however, the American Psychiatric Association Task Force Report que stioned the absolute nature of this contraindication and recommended a deta iled evaluation of the risk-benefit ratio and measures to decrease the risk s involved in treatment of affected persons. After a careful review, electr oconvulsive therapy was administered to a 61-year-old patient who had sever e medication-resistant major depression and a left temporal anaplastic astr ocytoma with brain edema. Special attention was given to reduce intracrania l pressure and minimize neurologic side effects. A course of eight nondomin ant unilateral electroconvulsive therapy treatments improved the depression significantly, without serious complications at the 4-month follow-up exam ination. With appropriate modifications, electroconvulsive therapy may be c onsidered a treatment option even in the presence of clinical evidence of i ncreased intracranial pressure. Further studies are needed to assess and mi nimize risks of electroconvulsive therapy in association with brain tumor.