Electroconvulsive Therapy in a Severely Depressed, Bipolar I Disorder Patient, Who Is a 3-Time Liver Transplant Recipient Due to Primary Sclerosing Cholangitis

Patients with bipolar I disorder who develop major depressive episodes with psychotic features and suicide ideations following severe episodes of mania can be difficult to treat with medications alone. Electroconvulsive therapy (ECT) is a treatment modality that can be quite helpful to these patients and lead to remission of depressive symptoms also while providing protection against mania. However the literature about using ECT in medically complex patients is sparse, which can limit guidance and knowledge on the specific risks of the procedure in specialized patient populations. We report in our own case the use of ECT to treat a major depressive episode in a young adult with bipolar I disorder who also has a history of 3 liver transplants in his childhood due to primary sclerosing cholangitis. Despite prior case reports relating the safety of ECT in liver transplant recipients, we discuss that our patient had a large intracranial hemorrhage during his first ECT that required 2 decompressive craniotomies and extensive physical rehabilitation. This case serves to expand the limited literature on the use of ECT in patients with history of liver transplants and to increase understanding of risks of the procedure in his specialized patient population.