LETTER TO EDITOR
Year : 2021 | Volume
: 26 | Issue : 2 | Page : 173--174
Electroconvulsive therapy for somatic symptom disorder with comorbid depression
Ajeet Sidana, Abhinav Agrawal, Apoorva Garg
Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India
Department of Psychiatry, Government Medical College and Hospital, Sector-32, Chandigarh (UT) - 160 030
|How to cite this article:|
Sidana A, Agrawal A, Garg A. Electroconvulsive therapy for somatic symptom disorder with comorbid depression.J Mental Health Hum Behav 2021;26:173-174
|How to cite this URL:|
Sidana A, Agrawal A, Garg A. Electroconvulsive therapy for somatic symptom disorder with comorbid depression. J Mental Health Hum Behav [serial online] 2021 [cited 2022 Aug 11 ];26:173-174
Available from: https://www.jmhhb.org/text.asp?2021/26/2/173/337166
Somatic symptom disorder (SSD) is characterized by preoccupation with one or more distressing physical symptoms, resulting in disruption of daily life. Literature on large case series of 28 patients with somatic symptoms reported improvement with electroconvulsive therapy (ECT). Here, the authors report a case of elderly female with SSD along with depression which was not improving with combination of antidepressant and antipsychotic. Treatment with ECT resulted in complete remission of troublesome somatic symptoms along with mood symptoms.
A 72-year-old female presented with illness of duration 24 years with gradual onset and episodic remittent course. The current exacerbation was of 4 weeks with complaints of not being able to eat as usual; she reported heaviness in her tongue and throat and even attributed it as if they have become of “metal.” She started remaining aloof, would get irritated if asked to eat, and lost interest in household activities. Decreased oral intake led to significant weight loss of approximately 10 kg. She constantly reported somatic complaints (throat has become of steel; body has become hard like plastic) as her reasons for not eating. On general physical examination, she was thin built, poorly nourished, and edentulous. Systemic examination including detailed throat/oral cavity examination revealed no abnormality.
Mental status examination revealed a thin built female, with decreased psychomotor activity having anxious and sad affect. Tone and volume of speech were low. The flow of thought was decreased with poverty of speech; she expressed hopelessness and excessive concern regarding somatic complaints. Her score on geriatric depression rating scale (GDRS) was 10/30 at baseline, indicates mild depression. Extensive investigations did not reveal any local or systemic pathology. Magnetic resonance imaging brain revealed global cerebral atrophy with chronic white matter ischemic changes and chronic calcified gliotic focus in right cerebellar hemisphere. Her Mini-Mental State Examination (MMSE) score was 27/31.
A diagnosis of SSD with comorbid major depressive episode was considered according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition system of classification. She was prescribed tablet sertraline which was titrated up to 100 mg along with tablet olanzapine titrated gradually up to 15 mg over a month. There was significant improvement in sadness of mood, sleep, and irritability and reduction in GDRS score without any changes in intensity of somatic complaints. The doses could not be optimized further due to side effects of medicines (constipation and drowsiness). Considering the poor oral intake, refractory nature of somatic symptoms, ECT was planned.
Bitemporal modified ECT administered twice weekly resulted in rapid resolution of the somatic symptoms within 5 sessions. Further 4 sessions were given that were gradually spaced out. Her GDRS score decreased to 1. She was continued on earlier doses of oral medication with sustained improvement in depressive as well as somatic symptoms at 2-month follow-up.
There are no guidelines for using ECT in patients with SSD. The literature has shown that the major depressive disorder and somatic symptoms share similar abnormalities in the neuroendocrine and immunologic systems, which could possibly explain the improvement reported in the index case. The existing literature also shows that older age is positive predictor of response to ECT., The improvement in index case supports the existing literature on effectiveness of ECT in resolution of somatic symptoms. ECT can be regarded as an option in patients with SSD with comorbid depression when patient does not respond to psychotropic medication and or psychotherapeutic interventions.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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