Although there is no specific age cutoff for electroconvulsive therapy (ECT) and no absolute contraindication to its use, very old age and the presence of cardiac conditions such as aortic stenosis are factors that may negatively affect the physician's decision to administer ECT in individual cases.
We report our follow-up of a 100-year-old woman with severe aortic stenosis who has received ECT safely for 5 years now. No cardiac complications have emerged during this period. Her prior unipolar depressive episode with catatonic features remains in remission with a single prophylactic ECT session every 3 months.
We have observed from our experience with this unique case that periodic multidisciplinary re-evaluation of the evolving risk-benefit profile of ECT is essential along with the inclusion of family members in this dialogue. Our patient's course illustrates that neither advanced age nor severe aortic stenosis is an absolute contraindication to ECT even over an extended period of time. Each case needs to be evaluated on its merits.
To our knowledge, this case represents the oldest patient in the literature where ECT has been administered safely for such an extended period in the setting of severe aortic stenosis.
From the *ECT Service, Department of Psychiatry, University of Pennsylvania School of Medicine; †Department of Anesthesiology, Pennsylvania Hospital, University of Pennsylvania School of Medicine; ‡Department of Psychiatry, Albert Einstein Medical Center; and §Department of Cardiology, Pennsylvania Hospital, University of Pennsylvania School of Medicine, Philadelphia, PA.
Received for publication May 6, 2011; accepted June 3, 2011.
Reprints: Mario A. Cristancho, MD, Room 2087, 3535 Market St, Philadelphia, PA 19104 (e-mail: firstname.lastname@example.org).
Dr Cristancho is supported by the NIMH-funded Clinical Research Scholars Program of the Department of Psychiatry, University of Pennsylvania.
The other authors declare no conflict of interest.