A 68-year-old woman with severe treatment-resistant major depressive disorder has failed four adequate antidepressant trials and remains in a life-threatening nutritional state due to refusal to eat. She is referred for electroconvulsive therapy (ECT). Which of the following is considered an absolute contraindication to ECT?

• A Age above 65 years
• B Current use of lithium
• C History of seizure disorder
• D There is no absolute contraindication to ECT; risk is assessed relative to the severity of the psychiatric condition ✓

Explanation

ECT has no absolute contraindications according to contemporary guidelines. All risks are relative and must be weighed against the life-threatening nature of the psychiatric illness. Relative risks include recent intracranial mass lesion, raised intracranial pressure, recent myocardial infarction, and aortic aneurysm, all of which require careful anaesthetic and medical management. Age, current lithium use (which may prolong seizures and requires dose reduction before ECT), and a history of seizures are not absolute contraindications.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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