Nonseizure Response to ECT in Older Adults with Bipolar Depression on Bumetanide

Abstract: Psychiatric presentations in older adults are complicated by chronic comorbidities, polypharmacy, and older age-related psychosocial changes. This case report discusses an unusual treatment response to ECT in a 75-year-old man with chronic bipolar disorder. There was no seizure activity on EEG and upon direct observation in 3 out of 7 ECT sessions. After an in-depth medication review of its impact on ECT, we propose that bumetanide could likely have contributed to the nonseizure response. Bumetanide was proposed as a potential antiepileptic agent, but the evidence for its effect on ECT is sparse. A proportion of older adults receiving ECT are likely to be on this FDA-approved diuretic for cardiovascular comorbidities. This case highlights the need for further studies to test for ECT-modifying of bumetanide.