The Combined Use of Bupropion, Lithium, and Venlafaxine During ECT: A Case of Prolonged Seizure Activity

Abstract

There is limited literature addressing the safety of administering electroconvulsive therapy (ECT) to patients concomitantly receiving bupropion monotherapy or in combination with other drugs that may alter the seizure threshold. We describe a prolonged seizure occurring during the first treatment of a course of ECT in an adult patient receiving long-term bupropion therapy, lithium, and venlafaxine.

A Translational Research Approach to Non - Convulsive Status Epilepticus - A Rare Case in Humans and a Retrospective Case - Control Review in Dogs

“…No other cases recorded patient's alcohol intake history or withdrawal and we considered alcohol withdrawal to be a relevant factor in our human case. Benzodiazepine reduction was also feature of this case and is noted to have occurred in three other cases of NCSE after ECT [3,7,12]. In six of nine reported cases of NCS, patients had received multiple ECT treatments (mean 6.5) (Figure 1).…”

A Case Report of ECT and Muscle Spasms

“…This patient may have experienced a mild prolonged seizure, given the improvement with the anti-seizure medication lorazepam, as well as previously documented prolonged seizure side effects from combining lithium with ECT treatment [3,[6][7][8]11]. Also, this patient had been receiving polypharmacy medication, including trazadone, duloxetine, buproprion, and lithium prior to ECT treatment.…”

“…Also, this patient had been receiving polypharmacy medication, including trazadone, duloxetine, buproprion, and lithium prior to ECT treatment. In the report by Conway and Nelson [7], the combination of lithium with buproprion and venlafaxine (in the same class as duloxetine) resulted in prolonged seizure activity. One of these medications or a combination of them together, may have led to the muscle spasms.…”

“…Adverse effects have been documented in patients receiving combined lithium and ECT treatment, and include prolonged seizures [3][4][5][6][7][8][9][10][11] prolonged apnea [5], serotonin syndrome with focal seizures [8], delirium [6,[12][13][14][15] and declining cognition [9,10]. Other studies have shown no adverse effects.…”

“…In the case report by Conway and Nelson [7] describing prolonged seizures during ECT, the patient was being treated with buproprion, venlafaxine, and lithium. A similar article by Rucker and Cook [11] recorded polypharmacy treatment of clomipramine, lithium, 1-tryptophan, quetiapine, and thyroxine leading to prolonged seizures with ECT.…”