The Efficacy and Safety of Concomitant Psychotropic Medication and Electroconvulsive Therapy (ECT)

Janjua, A. Umair; Dhingra, Amitha; Greenberg, Robert M.; McDonald, William M.

doi:10.1007/s40263-020-00729-1

Cited by 7 publications

(3 citation statements)

References 101 publications

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“…Consequently, the administered dosage of concomitant antidepressants and, in particular, benzodiazepines may affect the outcome of ECT. This may also explain the contradictory results in the current literature, in which studies reported positive, negative and absence of effects of concomitant benzodiazepines use on ECT response 45 . Additionally, higher dosages of concomitant used benzodiazepines (i.e., lorazepam) were associated with shorter seizure durations during ECT 46 .…”

Section: Discussionmentioning

confidence: 75%

Neural excitation/inhibition imbalance and the treatment of severe depression

Bruin

Zeidman

et al. 2021

Preprint

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An influential hypothesis holds that depression is related to a neural excitation/inhibition imbalance, but its role in the treatment of depression remains unclear. Here, we show that unmedicated patients with severe depression demonstrated reduced inhibition of brain-wide resting-state networks relative to healthy controls. Patients using antidepressants showed inhibition that was higher than unmedicated patients and comparable to controls, but they still suffered from severe depression. Subsequent treatment with electroconvulsive therapy (ECT) reduced depressive symptoms, but its effectiveness did not depend on changes in network inhibition. Concomitant pharmacotherapy increased the effectiveness of ECT, but only when the strength of neural inhibition before ECT was within the normal range and not when inhibition was excessive. These findings suggest that reversing the excitation/inhibition imbalance may not be sufficient nor necessary for the effective treatment of severe depression, and that brain-state informed pharmacotherapy management may enhance the effectiveness of ECT.

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Section: Discussionmentioning

confidence: 75%

Neural excitation/inhibition imbalance and the treatment of severe depression

Bruin

Zeidman

et al. 2021

Preprint

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“…For example, the broad classification of medical conditions in this analysis limits the ability to derive more refined findings that might be of clinical interest. To the extent that these observations reflect current practice, 12,31,32 they support the understanding of prolonged seizures during the administration of ECT.…”

Section: Discussionmentioning

confidence: 60%

“…Current practice often involves the coadministration of psychotropic medications and ECT, and the increasing number of drug options available inevitably place limits on practice-based studies. 31,32 Thus, although the sample size was sufficient to observe clinically relevant associations, the relatively small numbers may account for the absence of any expected dose-response relationship between prolongation of seizures and the medications studied. In addition, the implications of the results are limited by the absence of certain drugs of interest such as clozapine.…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Matched Comparison Study of Prolonged Seizures in ECT

Isenberg,

Dinwiddie,

Song

et al. 2023

J ECT

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Objective This study assessed the incidence of and risk factors for prolonged seizures (>180 sec) in electroconvulsive therapy (ECT). Method In 611 adult patients undergoing 6697 ECT treatments administered over a 2.5-year study period, 29 individuals experienced 42 prolonged seizures. A comparison sample (n = 29) was matched on sex, age, and treatment, and compared on psychiatric and medical diagnoses, as well as current medications. To examine the association between the characteristics and prolonged seizure, conditional logistic regression models or exact McNemar tests were conducted. Results Prolonged seizures occurred on average in 1 of every 167 treatments. No specific psychiatric disorders or medical conditions were associated with the prolonged seizure group. Antipsychotic drugs were used in a higher proportion of the comparison group than in the prolonged seizure group, suggesting a protective effect. Atropine was used in a lower proportion of the long seizure group than in the comparison group. No untoward sequelae occurred, and no progression to status epilepticus was observed. Conclusions Prolonged seizures appear to be an uncommon complication of ECT in adults. The characteristics examined in this study suggest limited association of psychotropic medications with prolonged seizures. Treatment of prolonged seizures was straightforward. Prolonged seizures had no impact on the course of treatment. Further exploration of prolonged seizures would enhance the generalizability of the findings from this single site study.

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Contemporary Anesthetic Evaluation and Management for Electroconvulsive Therapy

Salinas¹

2022

Advances in Anesthesia

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The Efficacy and Safety of Concomitant Psychotropic Medication and Electroconvulsive Therapy (ECT)

Cited by 7 publications

References 101 publications

Neural excitation/inhibition imbalance and the treatment of severe depression

Neural excitation/inhibition imbalance and the treatment of severe depression

A Retrospective Matched Comparison Study of Prolonged Seizures in ECT

Contemporary Anesthetic Evaluation and Management for Electroconvulsive Therapy

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