Early Postural Instability After First Electroconvulsive Therapy in Major Depressive Disorder: Implications for Patient Safety

Background: Electroconvulsive therapy (ECT) is an effective treatment for major depressive disorder but may cause transient neurological and motor side effects. Limited evidence exists regarding acute balance disturbances following treatment. Therefore, this study aimed to evaluate short-term changes in balance following the first ECT session in patients with Major Depressive Disorder (MDD). Methods: In this prospective observational repeated-measures study, twenty-two participants diagnosed with MDD were enrolled according to the inclusion criteria, such as being between the ages of 18–65, being diagnosed with major depression, and receiving ECT for the first time. The exclusion criteria were a diagnosis of any vestibular or neurological disease. The balance of the participants was evaluated with the Berg Balance Scale (BBS). The same physiotherapist performed the assessments before, at the 1st hour after ECT, and at the 24th hour after ECT. Results: Mean BBS scores were 55.04 ± 1.78 before ECT, 40.22 ± 2.54 at 1 h, and 54.86 ± 1.64 at 24 h after treatment. Balance decreased significantly at 1 h compared with baseline (mean difference: +14.82 points, p < 0.001) and improved significantly by 24 h (mean difference: −14.64 points, p < 0.001). No significant difference was observed between baseline and 24-h measurements (p = 0.640). Conclusions: These findings demonstrate a transient impairment in balance performance during the first hour following electroconvulsive therapy. Although fall risk was not directly assessed, careful monitoring and patient-safety precautions may be considered during early post-treatment mobilization.