Use of Thiamine in the Treatment of Post-electroconvulsive Therapy Delirium

Electroconvulsive therapy (ECT) is a safe and effective treatment for refractory depression, mania, and psychosis [8] [10]. The common adverse effects of ECT are cognitive impairments such as retrograde amnesia and delirium. However, these conditions are usually transient and have a self-limiting course [3]. In elderly patients, the postictal state (post-ECT delirium) is occasionally prolonged and often accompanied by disorientation and agitation. Post-ECT delirium is troublesome and may necessitate discontinuation or reduction of the course of ECT in some patients. Various pharmacotherapies with benzodiazepines or antipsychosis drugs are prescribed to prevent post-ECT delirium [1]. However, the beneficial effects of these agents have been controversial. Linton et al. [6] reported major depression and post-ECT delirium in 3 elderly patients, and they were the first to describe the successful treatment of post-ECT delirium with thiamine. To date, no other report has been published in this field of literature. We report a case of severe post-ECT delirium that presented during treatment for delusional depression and the dramatic beneficial effects of thiamine in treating it.

References

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