ECT for Parkinson's?

Although we did not mention ECT in our article,1 we agree that it may have a role in the treatment of specific symptoms of Parkinson's disease.

Parkinsonian patients who are severely depressed and whose condition is refractory to antidepressant therapy are candidates for ECT to treat their depression. Patients with drug-induced psychosis that is resistant to atypical neuroleptic medication who cannot tolerate reductions in their antiparkinsonian medication may also be candidates for ECT. However, ECT should not be offered to patients with dementia because there is the potential that such treatment may cause worsening of cognition and may induce delirium. There is insufficient evidence to suggest that motor symptoms related to Parkinson's disease should be treated with ECT, and in our opinion this should not be considered an indication for its use.

Mark Guttman Departments of Medicine and Psychiatry University of Toronto Toronto, Ont.