Nonresponse to Electroconvulsive Therapy (ECT) in a Patient with Depression, Substance Abuse and Personality Disorder

The authors report the case of a patient with a history of episodic, severe clinical depression who demonstrated an apparent absence of response to ECT. His illness was complicated by substance abuse and personality disorder. The vicissitudes of his course of treatment are described and the literature on ECT in depressed patients with substance abuse and personality disorder is reviewed. The heterogeneity of depression, and its relation to the ECT consultation process, is briefly discussed.