Recurrent Serotonin Syndrome After Ketamine-assisted Electroconvulsive Therapy: A Case Report and Review of the Literature.
Journal of psychiatric practice May 1, 2024 Aniruddha Deka, Emmanuel Joseph, Neha Sharma et al. 3 citations
A 72-year-old woman developed serotonin syndrome on two separate occasions after receiving ketamine for electroconvulsive therapy. Serotonin syndrome involves changes in mental status, autonomic function, and neuromuscular control. Electroconvulsive therapy may increase serotonin transmission by transiently opening the blood-brain barrier, raising antidepressant levels in the brain, and by acting on 5-HT1A and 5-HT2A receptors. Ketamine can also boost serotonin release by increasing glutamate activity in the medial prefrontal cortex. A literature review found five prior cases of serotonin syndrome with electroconvulsive therapy and one with ketamine alone. This is the only reported case of recurrent serotonin syndrome from combining both treatments. There is no evidence that adding ketamine to electroconvulsive therapy improves efficacy, so caution is warranted.