Using thiamine to reduce post‐ECT confusion

Abstract

Cognitive side-effects are commonly seen following electroconvulsive therapy which convey no therapeutic benefit but are troublesome to both patient and clinician. Various efforts have been made in the past to minimize these symptoms. Although modification of technical parameters related to ECT administration has led to some limited improvement in this regard, attention is now being increasingly focussed on pharmacological approaches. A number of agents have been explored in this context, however, as far as we are aware, the use of thiamine has not yet been investigated. We present three cases of elderly patients undergoing ECT for major depression in whom thiamine administration was associated with beneficial effects on post-ECT confusion. We review the evidence suggesting that thiamine deficiency may be implicated in the confusional state following ECT and recommend that consideration be given to its use in preventing and treating this problematic side-effect, especially in elderly patients.

Double-blind, randomized placebo-controlled clinical trial of benfotiamine for severe alcohol dependence

“…Nutritional factors and thiamine deficiency specifically have been found to influence psychological functioning including mood and the expression of psychological symptoms that may moderate alcohol use and abuse (Abou-Saleh and Coppen, 1986; 2006; Bell et al, 1992; Benton and Donohoe, 1999; Benton et al, 1995a; 1995b; 1997; Botez et al, 1977; Brozek, 1957; Heseker et al, 1995; Linton, 2002; Smidt et al, 1991; Sterner and Price, 1973; Zhang et al, 2013). Neurological damage secondary to alcoholism and related nutritional deficiencies may contribute to the continuation of abusive drinking by impairing brain processes that regulate behavior (Manzardo and Penick, 2006; 2008; Pfefferbaum et al, 2000; 2009; Pitel et al, 2011; Sullivan and Pfefferbaum, 2005; Schulte et al, 2010).…”

Change in psychiatric symptomatology after benfotiamine treatment in males is related to lifetime alcoholism severity

“…Systematic studies examining the association between thiamine status and mood have reported a rapid onset of irritability and depression symptoms in response to acute thiamine deprivation that markedly deteriorated with time but was readily reversible with thiamine supplementation (Brozek, 1957). Numerous randomized trials have reported improved mood, increased feelings of well-being and decreased fatigue in response to thiamine supplementation of adults with and without defined deficiency (Bell et al, 1992; Benton et al, 1995a; 1995b; 1997; 1999; Heseker et al, 1995; Linton et al, 2002; Smidt et al, 1991). Zhang et al, (2013) also found an inverse correlation between blood thiamine levels and depression symptoms in older, Chinese men and women (50–70 yrs) from the general population.…”

“…Depression and other psychiatric disorders have been associated with thiamine deficiency in both Wernicke-Korsakoff syndrome and in the elderly (Bell et al, 1992; Benton et al, 1995a, 1995b, 1997, 1999; Brozek and Caster, 1957; Heseker et al, 1995; Linton et al, 2002; Smidt et al, 1991; Zhang et al, 2013). The primary actions of thiamine deficiency on oxidative metabolism increases oxidative stress leading to secondary activation of microglia and inflammatory chemokines which are believed to contribute to neurodegeneration and exacerbation of the neurotoxic effects of alcohol (Calingasan et al, 1999; Desjardins et al, 2005; Gibson and Blass, 2007; Hazell and Butterworth, 2009; Ke et al, 2003; Yang et al, 2011).…”

Use of Thiamine in the Treatment of Post-electroconvulsive Therapy Delirium

“…We speculate that thiamine defi ciency caused by decreased dietary intake of thiamine and the eff ect of ECT procedures may together contribute to the development of post-ECT delirium. Linton et al [6] also suggested that thiamine defi ciency arising from anorexia may mediate severe post-ECT delirium, and they reported that thiamine supplementation has a benefi cial eff ect in treating post-ECT delirium. ECT-associated thiamine shortage may also be caused by another factor: neuronal discharges induced by ECT result in increased neuronal glucose metabolism, which in turn leads to thiamine consumption and hence results in relative thiamine defi ciency [2] .…”

“…However, the benefi cial eff ects of these agents have been controversial. Linton et al [6] reported major depression and post-ECT delirium in 3 elderly patients, and they were the fi rst to describe the successful treatment of post-ECT delirium with thiamine. To date, no other report has been published in this fi eld of literature.…”