Successful Treatment With Electroconvulsive Therapy of a Patient With Bipolar Disorder and a 7-mm Cerebral Aneurysm.

To the Editor: M s N is a 54-year-old woman whowas admitted to our inpatient unit for exacerbation of bipolar depression, type I. Six months before admission, she experienced a brief manic episode, after which her mood dropped precipitously. After medication adjustments failed to alleviate her depression, shewas admitted for expedited initiation of electroconvulsive therapy (ECT). At the time of admission, her medications included lamotrigine, lithium, and olanzapine. Her medical history was notable for hypertension, as well as a 7-mm cerebral aneurysm located in the left cavernous sinus. Her hypertension had been successfully managed with amlodipine/valsartan/hydrochlorothiazide 10/160/12.5 mg daily. The aneurysm had been discovered incidentally from magnetic resonance imaging 4 years ago that she had for a work-up of diplopia (since resolved). Given the relatively low risk of spontaneous rupture associated with an aneurysm of this size, the patient had annual follow-up with neurosurgery for expectant management without intervention. The aneurysm had remained stable in size for the following 4 years. After consultation with neurosurgery and anesthesiology, as well as informed consent including a thorough discussion of the risks and benefits of the treatment, right unilateral ECT was initiated, administered 3 times a week using a MECTA Spectrum 5000Q machine. Methohexital was used as the anesthetic agent (dose range, 80–150 mg), succinylcholine was used as the paralytic agent (dose range,