Objective: To describe a case of motoric, affective, and psychotic symptoms improving in PD following ECT.

Background: Parkinson’s disease (PD) is a neurodegenerative disease caused by dopaminergic depletion in the basal ganglia. Non-motor features can independently include both depression and psychosis. Electroconvulsive therapy (ECT) is a treatment for a range of psychiatric conditions, including medication-refractory depression. There is limited data regarding the effect of ECT on motor, depressive, and psychotic symptoms in PD.

Method: Case Report.

Results: A 62-year-old man had onset of left-handed tremor and rigidity, with subsequent abnormal ioflupane I123 SPECT (DaTscan®), supporting a diagnosis of PD. He had an initial motor response to levodopa. One year later, he developed medication-refractory depression. There was concurrent worsening of his motor symptoms, with poor response to increased levodopa. He presented to our clinic with significant motor parkinsonism, severe vegetative depression, and somatic pain associated with Cotard delusions that his bones and organs were broken. UPDRS Part 3 score at the time was 46. He was institutionalized a month later and received aggressive psychiatric care, including six sessions of ECT.
Three months following ECT, he demonstrated profound improvement. He weaned off levodopa. His depression and delusions were resolved. He remained on 150mg quietiapine, 150mg venlafaxine, and 15mg mirtazapine. Off Levodopa, follow up UPDRS Part 3 was 17. Quetiapine was reduced to 100mg daily without clinical worsening. He remains off levodopa 6 months later.

Conclusion: Both PD and psychotic depression involve changes in dopaminergic transmission and neuronal dopamine response. The effect of ECT on reducing PD symptoms may be mediated through striatal dopamine. Literature suggests that ECT may have “effects on [dopamine] release, receptor sensitivity, and other modulatory mechanisms.” This case demonstrates that ECT may be effective for the motoric, affective, and psychotic symptoms of PD though the mechanism is likely complex. The literature has few randomized control trials describing this relationship. Additional investigation is warranted.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-case-of-improved-psychotic-depression-and-motor-symptoms-in-parkinsons-disease-following-electroconvulsive-therapy-ect/