Serotonin Syndrome after Electroconvulsive Therapy for Refractory Depression

Serotonin syndrome is a toxicological entity with potential morbidity and mortality if unrecognized and untreated. Toxicity can occur after dose or increase or initiation of additional serotonergic medication, but can also be idiopathic. We report a case in which serotonin syndrome occurred after electroconvulsive therapy in the absence of escalation of medical therapy, and theorize a pathophysiologic mechanism based on basic science of blood–brain barrier integrity change after ECT.