Early reports cautioned against the combination of lithium and electroconvulsive therapy (ECT), citing risk of excessive cognitive disturbance, prolonged apnea, and spontaneous seizures. However, recent case series with larger numbers of patients indicate that the combination may be used safely and with optimal efficacy in certain clinical circumstances. In this report, we describe 12 patients in whom the combination of lithium and ECT was deemed safe. We also provide a comprehensive review of published literature and provide detailed recommendations for clinical practice.

Electroconvulsive therapy (ECT) is used to treat major depressive illness, especially in elderly and medically frail patients. Not uncommonly, these patients have cardiac pacemakers or implantable cardioverter defibrillators (ICDs). Only a few case reports in the literature describe the use of ECT in such patients. Herein we review our ECT experience treating 26 pacemaker patients and 3 ICD patients. All patients obtained significant antidepressant benefits with ETC. Only one serious cardiac event occurred, a case of supraventricular tachycardia (SVT) requiring a stay on the cardiac intensive care unit. The SVT resolved and the patient went on to receive further uncomplicated ECT treatments. We conclude from this experience that with proper pre-ECT cardiac and pacemaker/defibrillator assessment, ECT can be safely and effectively administered to patients with an implanted cardiac device.

No abstract

Concerns have been expressed regarding the use of general anesthesia for electroconvulsive therapy (ECT) in patients taking monoamine oxidase inhibitors (MAOIs). We review the published literature and present 4 new cases and conclude that there is no evidence of a dangerous interaction between ECT and MAOI use. In general, a cautious approach would be to discontinue MAOIs before ECT if the medication has not been helpful; however, there is no need for a washout interval before starting ECT. Furthermore, if there is otherwise a reason for continuing the MAOI, it can be continued during index ECT or initiated during maintenance ECT.

The ECT curriculum allows residents to become familiar with the theory and practice of ECT. Guided study, informed observation, and hands-on learning ensure that residents become skillful in executing pre-ECT psychiatric and medical assessment, ECT procedure, and immediate post-ECT care.

In patients referred for ECT, baseline QTc dispersion does not correlate with presence of cardiac illness or concomitant psychotropic usage.

Electroconvulsive therapy (ECT) is associated with a brief rise in intraocular pressure (IOP). The significance of this in glaucomatous patients is unknown. We present a patient with bilateral glaucoma status after surgery in the right eye who underwent IOP monitoring during 1 of his ECT treatments. Baseline eye pressures were normal at 16 mm Hg and 18 mm Hg immediately before the treatment in the right and left eyes, respectively. Fifteen seconds after seizure induction, there was an approximately 5 mm Hg rise in IOP in the left eye, which lasted approximately 5 minutes before returning to baseline. In the right eye, there was virtually no change in pressure during the seizure. Though further research would be helpful, this case provides evidence that in a glaucomatous patient controlled with medicines or surgery, ECT probably will not cause a significant rise in IOP.

No abstract