Lithium Continuation Therapy Following Electroconvulsive Therapy

Coppen, Alec; Abou‐Saleh, Mohammed T.; Milln, P; Bailey, John E.; Metcalfe, Maryse; Burns, B. H.; Armond, A. D.

doi:10.1192/bjp.139.4.284

Cited by 81 publications

(27 citation statements)

References 12 publications

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“…In the first prospective study of lithium continuation therapy following ECT, a group of 38 patients who had responded to ECT were studied (Coppen et al 1981; Abou-Saleh and Coppen 1988). The patients were randomly allocated to receive either placebo or lithium therapy for 1 year.…”

Section: Lithium As a Continuation Treatment Following Ectmentioning

confidence: 99%

Lithium in the episode and suicide prophylaxis and in augmenting strategies in patients with unipolar depression

Abou‐Saleh

Müller‐Oerlinghausen

Coppen³

2017

Int J Bipolar Disord

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BackgroundDepressive disorders are a leading cause of the global burden of disease and are associated with high recurrent often continuing morbidity and high excess mortality by suicide and cardiovascular disease. Whilst there are established, effective and cost-effective treatments for depression, their long-term management is often neglected: there is continuing controversy over the case of need for long-term treatment including lifelong treatment and safety issues.Objective and methodsIn this narrative review, we critically examine the evidence for the effectiveness and safety of lithium salts in the long-term management of unipolar depression. We refer to existing recent international guidelines as well as the scientific literature selectively and against the background of our longstanding experience with patients suffering from unipolar depression who are often under treated or inappropriately treated.Results and discussionAccording to many studies mostly dating back to the 1970/1980s, lithium is efficacious in the prophylaxis of unipolar depression particularly depression with melancholia and delusional depression and showing a clearly episodic course. Also the efficacy of lithium maintenance treatment following recovery by ECT has been clearly shown. Moreover, convincing evidence exists that lithium has added value and benefit for its unique anti-suicidal effects as well as reducing mortality by other causes. The anti-suicidal effect has been convincingly demonstrated in bipolar as well as in unipolar patients. Nevertheless its use in the management of patients with unipolar depression has not been properly recognized by a majority of textbooks and guidelines. Whilst it has been well considered as an effective treatment for depression that has not responded to antidepressants as an adjunct treatment, also called augmentation, it has been much less recommended for the prevention of recurrent episodes of unipolar depression. One of the reasons for this neglect is the blurring of the diagnosis “unipolar depression” by modern diagnostic tools. Lithium will hardly work in a patient with “unipolar depression spectrum disease”.ConclusionsWe conclude that lithium is an effective prophylactic treatment for carefully selected patients with unipolar depression and is safe when prescribed in recommended doses/plasma lithium levels and with regular, careful monitoring. We propose that lithium prophylaxis can be indicated in patients with unipolar depression and that the occurrence of 2 episodes of depression within 5 years is a practical criterion for starting lithium prophylaxis particularly in severe depression with psychotic features and high suicidal risk. Furthermore, an indication might be considered especially in unipolar patients in whom a bipolar background is suspected. In some cases, lithium prophylaxis may be recommended after a single episode of depression that is severe with high suicidal risk and continued life-long.

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Section: Lithium As a Continuation Treatment Following Ectmentioning

confidence: 99%

Lithium in the episode and suicide prophylaxis and in augmenting strategies in patients with unipolar depression

Abou‐Saleh

Müller‐Oerlinghausen

Coppen³

2017

Int J Bipolar Disord

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“…Some studies have shown a neurotoxic interaction between lithium and ECT, and others have shown no significant increase in the incidence of complications [25–27]. Although both lithium and ECT can independently produce a delirium, Penney et al found that concurrent lithium and ECT is associated with an increased incidence of severe or prolonged confusion [26].…”

Section: Discussionmentioning

confidence: 99%

Delayed Onset and Prolonged ECT-Related Delirium

Hassamal

Pandurangi

Venkatachalam

et al. 2013

Case Reports in Psychiatry

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Electroconvulsive therapy (ECT) is effective in the treatment of depression. Delayed post-ECT delirium is rare but can occur in a small subset of patients with risk factors and in most cases resolves with the use of psychotropic medications. We report a unique presentation of a patient who developed a delayed post-ECT delirium with fecal incontinence that commenced 24 hours after the administration of ECT. The condition resolved spontaneously after 48 hours without the use of psychotropic medications.

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“…Lethargy, prolonged confusion and prolonged or recurrent seizures have been reported [101]. Although several case series have not supported an increased risk of these complications with the combined use of lithium and ECT [102][103][104], some authors do not recommend their concurrent use [101]. The American Psychiatric Association recommends either discontinuation of lithium or a reduction in dosage when ECT is initiated [105,106].…”

Section: Lithiummentioning

confidence: 99%

Risk of seizures associated with psychotropic medications: emphasis on new drugs and new findings

Lee¹,

Finley²,

Alldredge³

2003

Expert Opinion on Drug Safety

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Psychotropic medications in the classes of antidepressants, antipsychotics and mood stabilisers have been recognised in the literature and clinical settings as having high epileptogenic potential. Among these three classes, clozapine, tricyclic antidepressants (TCAs) and lithium are agents that clinicians have historically recognised as precipitants of drug-induced seizures. There are few reports that review the epileptogenic risk of newer psychotropic agents; in this qualitative review, the authors provide an update on the most recently published reports on seizures associated with antidepressants, antipsychotics, mood stabilisers, anxiolytics and sedative-hypnotics. In general, the epileptogenic risks of the newer psychotropic agents appear to be quite low as long as dosing strategies are consistent with recommended guidelines. Whilst newer psychotropic medications appear to be safe in patients with epilepsy, few studies have specifically addressed this population. In addition, the potential for drug interactions between antiepileptic drugs and psychotropics may be substantial with certain agents. For example, many psychotropes are both substrates and inhibitors of cytochrome P450 (CYP450) isoenzymes, whilst many antiepileptic drugs are both substrates and inducers of CYP450 activity. Every attempt should be made to minimise potential interactions when these agents are concomitantly administered.

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Lithium Continuation Therapy Following Electroconvulsive Therapy

Cited by 81 publications

References 12 publications

Lithium in the episode and suicide prophylaxis and in augmenting strategies in patients with unipolar depression

Lithium in the episode and suicide prophylaxis and in augmenting strategies in patients with unipolar depression

Delayed Onset and Prolonged ECT-Related Delirium

Risk of seizures associated with psychotropic medications: emphasis on new drugs and new findings

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