Case ReportThe Effect of Electroconvulsive Therapy on Hypoperfusion in Psychotic Bipolar Depression A Case StudyDe Smet, Céline Julie MD*†; Sabbe, Bernard MD‡§; Oldenburg, J.F.E. PhD‡§Author Information From the *Adult Care Department, Psychiatric Centre VAGGA; †University of Antwerp; ‡University Department, Psychiatric Hospital Duffel; and §Collaborative Antwerp Psychiatric Research Institute, Faculty of Medicine, University of Antwerp, Belgium. Received for publication May 29, 2017; accepted December 15, 2017. Reprints: Céline De Smet, MD, VAGGA, Belgiëlei 147, 2018 Antwerp, Belgium (e-mail: [email protected]). This work was supported by the university department Psychiatric Hospital Duffel—Antwerp University Hospital Duffel. The authors have no conflicts of interest or financial disclosures to report. The Journal of ECT: June 2018 - Volume 34 - Issue 2 - p 124-126 doi: 10.1097/YCT.0000000000000487 Buy Metrics Abstract The pharmacological treatment of bipolar depression has low response rates. Twenty percent to 30% of patients have an insufficient response to medication. The guidelines suggest that electroconvulsive therapy (ECT) is the next step. The aim of this case study is to evaluate the effect of ECT on the perfusion of the brain in bipolar depression, while monitoring effects on mood and cognition. We present a case study of 56-year-old female patient who suffered from a psychotic depression and cognitive impairment. Before ECT, she took several antidepressants and atypical antipsychotics, but there was no improvement in her symptoms. By using single-photon emission computed tomography, we obtained the status of the regional cerebral blood flow and found a decreased perfusion in the anterior part of the left temporal lobe, the posterior part of the right temporal lobe, and in the left gyrus frontalis inferior. This is consistent with previous findings. Electroconvulsive therapy resulted in a resolution of the patient's depression and an improvement in her neurocognitive performance. Markedly, this was only in visual learning and working memory, domains in which the patient was already relatively stronger pre-ECT treatment. A new single-photon emission computed tomography, 4 weeks after the last ECT course, showed normalization of the regional cerebral blood flow. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.