Antiepileptics in Electroconvulsive Therapy

Abstract

Although prior conventional wisdom strongly recommended complete discontinuation of medications increasing the seizure threshold before electroconvulsive therapy (ECT), more recent literature suggests that anticonvulsants should be considered a relative rather than an absolute contraindication to proceeding with therapy. Most literature regarding the use of use antiepileptic drugs in ECT focuses on antiepileptic mood stabilizers with which most psychiatrists are familiar. However, there is considerably less information available about the use of newer antiepileptics in conjunction with ECT, which may be prescribed to a patient with epilepsy or off-label for psychiatric reasons.In this article, we provide a mechanism-based review of recent available literature concerning the use of antiepileptics during ECT and discuss which medications have the most robust evidence supporting their continued use in select patients. Finally, we highlight important considerations for psychiatrists when deciding how to proceed with patients on antiepileptics who require ECT.

Ketamine or ECT? What Have We Learned From the KetECT and ELEKT-D Trials?

“…In the ELEKT-D trial, 25% of the patients were taking anticonvulsant medications, and 31% were prescribed benzodiazepines. Although concerns about their potential impact on ECT efficacy have been raised ( Cinderella et al, 2022 ), the evidence regarding anticonvulsants’ influence on ECT’s efficacy in depression remains limited ( Stromgren et al, 1980 ; Zolezzi, 2016 ; Brus et al, 2017 ). Most studies in this area have primarily focused on patients with schizophrenia and mania ( Jahangard et al, 2012 ; Haghighi et al, 2013 ; Kaster et al, 2017 ; Rakesh et al, 2017 ).…”

Electroconvulsive therapy and seizure: a double-edged sword?

“…ECT can be safely used in patients with epilepsy, and seizure frequency did not change after ECT [ 12 , 14 ]. Several studies of patients with epilepsy have also been conducted on whether antiseizure medication (ASM) should be temporarily discontinued or reduced when performing ECT [ 12 , 38 ]. In most cases, brief seizures, which are required for the therapeutic effect of ECT, were induced successfully without adjustment of ASM, and psychiatric symptoms were treated effectively [ 38 ].…”