A 27-year-old man was admitted with a 6 years history of low mood, lethargy, anhedonia, persistent gloomy feeling, repeated suicidal thoughts with 1-2 unsuccessful attempts, decreased appetite and non-refreshing sleep. He was diagnosed as chronic depression and was started on Tab Sertraline 50 mg which was hiked slowly to 100mg over few weeks. ECT was also started considering his suicidality. He started to show a response to this regimen. After 6 ECT sessions, he was found to be over talkative, irritable with occasional expansive mood, increased psychomotor activity, having racing thoughts etc.
He was thus thought to have manic symptoms and ECT was thought to be responsible for such. Sertraline, being a SSRI has less switch potentiality and a possible role of it to cause this switch was not thought off though it was stopped. What to do next? How to tackle this ECT-induced switch? What…
