Low-Dose Atropine in Electroconvulsive Therapy

Self Cite

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Safety of Electroconvulsive Therapy in Patients With Unrepaired Abdominal Aortic Aneurysm

Mueller¹,

Albin²,

Barnes³

et al. 2009

Self Cite

“…However, the use of ketamine at full anesthetic doses can lead to psychotogenic adverse effects (eg, hallucinations), 72 although there are clinical impressions that the incidence of these adverse effects is lower in the context of ECT. 73 Nevertheless, in some ECT patients, these adverse effects are problematic and preclude the use of ketamine anesthesia. 69 Because the psychotogenic effects are dose-related, 74 using a subanesthetic dose of ketamine as an adjunct while anesthesia is mainly given with barbiturate or other agents may be an effective strategy.…”

Section: Ketaminementioning

confidence: 99%

Augmentation Strategies in Electroconvulsive Therapy

Loo¹,

Simpson²,

MacPherson³

2010

Electroconvulsive therapy (ECT) is a highly effective treatment, but strategies to enhance therapeutic outcomes are occasionally needed. This review examines the evidence for approaches used for enhancing seizure production: hyperventilation, pretreatment with xanthines, and use of remifentanil or ketamine in ECT anesthesia. Hyperventilation may be a useful strategy to enhance seizure production, but its effects on ECT outcomes have not been systematically studied and require further research. Pretreatment with caffeine, theophylline or aminophylline (xanthines) prolongs the duration of ECT seizures but has not been clearly shown in controlled trials to increase efficacy. Caution is also warranted because their use may be associated with significant adverse effects. There are case reports of the usefulness of remifentanil in assisting seizure induction by reducing the dose of barbiturate anesthetic required, but there are no controlled data on whether it independently enhances efficacy outcomes. Preliminary evidence suggests that ketamine and ECT may have synergistic antidepressant effects, although this needs to be further examined in randomized controlled trials.

“…Although ketamine use may have physiological disadvantages in some patients such as increased cardiac workload, 19 this class of agents may prove useful both as primary treatment modalities and as augmentation strategies that can be safely combined with ECT to provide more rapid relief from the disabling and dangerous symptoms of this disorder.…”

Section: Discussionmentioning

confidence: 99%

Rapid Relief of Severe Major Depressive Disorder by Use of Preoperative Ketamine and Electroconvulsive Therapy

Goforth

Holsinger²

2007

Major depressive disorder is a difficult-to-treat and recurrent debilitating disorder. All approved somatic treatments for major depression to date require a significant time lapse before demonstrating an antidepressant effect. However, emerging evidence indicates a potential role for the use of ketamine to rapidly relieve symptoms of major depression. We present a case of severe, recurrent major depressive disorder that demonstrated marked improvement within 8 hours of receiving a preoperative dose of ketamine and 1 treatment of electroconvulsive therapy with bitemporal electrode placement. This case is supportive of a role of ketamine in relieving symptoms of major depressive disorder rapidly and safely.