the Mini Mental State Examination. Her long-standing hypertension was well controlled by atenolol 50 mg daily.
She was treated initially with mirtazepine and later with venlafaxine. Lithium augmentation proved ineffective in both instances. Whilst on venlafaxine, her condition continued to deteriorate. She refused to eat and drink adequately, and started to neglect her personal hygiene. It was decided to treat her with ECT. Provisions of the Mental Health Act were used as she refused to give consent. One morning, after the routine anaesthesia, oxygenation and muscle relaxation, a bilateral ECT was given. A dose of 150 mC produced very mild fits lasting less than 20 seconds. It took her 20 minutes to recover from the anaesthesia and another 80 minutes to become fully conscious. During the recovery period her blood pressure initially fell from the normal 130/90 mm of Hg to 84/ 40 mm of Hg, and she required intravenous fluid. Gradually, her blood pressure started to rise, and went up to 181/1 04 mm of Hg. She had to be transferred to the local general hospital because she did not look well at all. Her blood pressure continued rising, and a maximum 200/88 mm of Hg were recorded in the hospital. She was transferred back to the psychiatric ward after a few hours of medical observation. No further ECT was attempted despite her continued deterioration. A few days later, she developed pneumonia of which she died eventually.
In the present case, a prolonged recovery from the anaesthesia and an unstable blood pressure immediately after the ECT raised the question of whether the concomitant use of venlafaxine and ECT was the possible cause. If so, despite its reported safety, clinicians have to be extremely cautious until further research findings are made available.