Abstract
Differences in electroconvulsive therapy (ECT) between children/adolescents and adults are summarized in the introduction of this paper. The authors present a case of a 14-year-old girl with a treatment-refractory bipolar depression, whose symptomatology did not improve on the treatment with three different antidepressant agents (sertraline, venlafaxine, mirtazapine).
Lack of improvement alternated with a switch to hypomania or mixed phase. The effect of simultaneously administered lithium or atypical antipsychotics with mood stabilization properties (risperidone, olanzapine, aripiprazole, and quetiapine) was questionable; only valproate brought some therapeutic success.
However, long-term stabilization was not achieved even by a combination of two antidepressants (venlafaxine and mirtazapine) with valproate. The positive turn in the patients treatment had not been accomplished until the administration of electroconvulsive therapy, the course of which consisted of ten ECT sessions in a twice a week regimen.
Thymatron device was used. Only the complete remission uncovered psychopathology connected with a developing borderline personality disorder, which led to an initiation of a long-term psychotherapy.
The patient was discharged from the hospital on a combination of val-proate with moclobemide.