Objectives:
Systemic Lupus Erythematosus (SLE) may have serious neuropsychiatric complications. The role of electroconvulsive therapy (ECT) in these cases has not been established. Here we illustrate the case of a patient with severe depression and psychotic symptoms associated with SLE.

Background:
SLE neuropsychiatric complications include psychosis and depression. These are managed by treating the underlying illness, although ECT could have an impact in refractory cases.

Materials and Methods:
Case report. 49 year old female patient, in treatment for SLE and major depressive disorder, presented with a two-week history of depressed mood, delusional ideas of guilt and paranoia, and catatonic symptoms. Laboratory revealed normal blood count, renal, hepatic and thyroid function. Normal CSF analysis. Autoimmune panel positive for lupic anticoagulant and anti-beta2-glycoprotein I antibodies. Normal brain CT.

Results and Conclusions:
Treatment initiated with prednisone, cyclophosphamide, benzodiazepines, venlafaxine and olanzapine. Catatonic symptoms remitted but depressive and psychotic features persisted so ECT was indicated.
Initial acute phase consisted of 9 sessions of right unilateral (RUL) brief pulse width (0.3 ms) ECT tri-weekly. Charge was 230 mC (6x seizure threshold), then raised to 268 mC. Due to lack of response, 3 sessions of bilateral treatment were conducted (final charge 576 mC). Seizure duration averaged 21 seconds. No adverse reactions reported. Outcome measure was the CGI-Efficacy Index. Pre-ECT CGI-SI score was 6 (severely ill) and post-ECT CGI-I was 4 (no improvement).

Conclusions: This case suggests that ECT has a poor impact in the treatment of severe depression with psychotic features in SLE, although further investigation is warranted.

Case report of a patient with refractory neurolupus treated with electroconvulsive therapy unsuccessfully with lack of clinical response.