Medication management during electroconvulsant therapy

Zolezzi, Monica

doi:10.2147/ndt.s100908

Cited by 35 publications

(23 citation statements)

References 47 publications

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“…However, it more than likely reflected the natural course of an ECT treatment regime. In addition, sertraline and olanzapine can theoretically lower seizure threshold, and some data have suggested beneficial and additive efficacy of second-generation antipsychotics (SGAs) to ECT, notably with clozapine [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, studies have shown the number of acute ECT treatments to be highly variable, and its efficacy is affected by a number of factors including treatment frequency [ 9 ], condition treated and its severity [ 10 ], the ECT pulse width [ 12 ] and electrode placement [ 13 ]. The concurrent use of pharmacological treatment for psychiatric and non-psychiatric conditions can also interact with ECT treatment [ 27 ]. This may call for a re-consideration of the ECT treatment regime, especially in cases where response may not have been observed by the later part of a treatment course.…”

Section: Discussionmentioning

confidence: 99%

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Case report: delayed response after electroconvulsive therapy in a patient with major depressive disorder

et al. 2021

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Background Major depressive disorder and associated mood syndromes are amongst the most common psychiatric disorders. To date, electroconvulsive therapy (ECT) is considered the most effective short-term treatment for patients with severe or treatment-resistant depression. In clinical practice, there is considerable variation in the ECT dosing schedule, with the number of sessions typically ranging from 6 to 12, with early antidepressant effects being predictive of increased positive outcomes. We describe here an unusual case of a female patient with severe depression who did not respond to ECT until the 11th session, after which she had shown a drastic improvement in her mental state. Case presentation A 75-year-old female presented to the old age psychiatry inpatient unit with new onset dysphoric mood, anhedonia, and severe negativity. She scored 23 on the 17-item Hamilton Rating Scale for Depression (HAM-D), and was rated 6 on Clinical Global Impression severity (CGIS) by the responsible clinician. She suffered from post-natal depression fifty years ago and was successfully treated with ECT. She was therefore initiated on a course of ECT treatment. Her condition initially deteriorated, displaying features of catatonia and psychosis, unresponsive to ECT treatment or concurrent psychotropic medications. After 11th ECT session, she started to show signs of clinical improvement and returned close to her baseline mental state after a total of 17 ECT sessions. She remained well 3 months post-treatment, scoring 4 on HAM-D, Clinical Global Improvement or change (CGI-C) rated as 1 (very much improved). The diagnosis was ICD-10 F32.3 severe depressive episode with psychotic symptoms. Conclusions we describe here an unusual case of delayed response to electroconvulsive therapy in the treatment of severe depressive disorder. Studies have shown the number of acute ECT treatments to be highly variable, affected by a number of factors including treatment frequency, condition treated and its severity, the ECT technical parameters, as well as concurrent use of pharmacological treatment. This may call for re-consideration of the current ECT treatment guidelines, requiring more research to help stratify and standardize the treatment regime.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Case report: delayed response after electroconvulsive therapy in a patient with major depressive disorder

et al. 2021

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“…In addition, the short-acting muscle relaxant succinylcholine minimises physical musculoskeletal manifestations of induced seizures, while allowing seizure activity to proceed in the brain tissue. 28 This complete attenuation of the clinical signs of a seizure means that the only way to record seizure duration is by electroencephalography (EEG). In the current study, seizure duration could not established either via clinical observation or EEG recordings, due to a lack of proper equipment and the absence of a specific clinical directive.…”

Section: Discussionmentioning

confidence: 99%

“…9 Succinylcholine is the gold standard for modified ECT sessions. 28 As mentioned earlier, it is recommended that the lowest possible dose of muscle relaxants be used so as to maintain minimal muscle fasciculation and obtain visual evidence of seizures. 29 The goal is to prevent massive tonic-clonic seizures resulting in movements that could lead to soft tissue/ bony injury, rhabdomyolysis or hyperkalemia.…”

Section: Discussionmentioning

confidence: 99%

General Anaesthesia Protocols for Patients Undergoing Electroconvulsive Therapy: Retrospective analysis of 504 sessions over a five-year period at a tertiary care hospital in Oman

Narayanan

Lal

Sinawi

2017

SQUMJ

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abstract:Objectives: This study aimed to review general anaesthesia protocols for patients undergoing electroconvulsive therapy (ECT) at a tertiary care hospital in Oman, particularly with regards to clinical profile, potential drug interactions and patient outcomes. Methods: This retrospective study took place at the Sultan Qaboos University Hospital (SQUH), Muscat, Oman. The electronic medical records of patients undergoing ECT at SQUH between January 2010 and December 2014 were reviewed for demographic characteristics and therapy details. Results: A total of 504 modified ECT sessions were performed on 57 patients during the study period. All of the patients underwent a uniform general anaesthetic regimen consisting of propofol and succinylcholine; however, they received different doses between sessions, as determined by the treating anaesthesiologist. Variations in drug doses between sessions in the same patient could not be attributed to any particular factor. Self-limiting tachycardia and hypertension were periprocedural complications noted among all patients. One patient developed aspiration pneumonitis (1.8%). Conclusion: All patients undergoing ECT received a general anaesthetic regimen including propofol and succinylcholine. However, the interplay of anaesthetic drugs with ECT efficacy could not be established due to a lack of comprehensive data, particularly with respect to seizure duration. In addition, the impact of concurrent antipsychotic therapy on anaesthetic dose and subsequent complications could not be determined. General Anaesthesia Protocols for PatientsUndergoing Electroconvulsive Therapy

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“…The patients underwent bilateral ECT procedures using the Thymatron System IV (Somatics, LLC) device at standard parameters as previously described [13]. The procedures were performed under intravenous anesthesia with propofol and suxamethonium, as well as atropine, in the appropriate doses [14, 15]. EEG monitoring was used to confirm the occurrence of seizures.…”

Section: Methodsmentioning

confidence: 99%

The impact of electroconvulsive therapy on the spatial QRS-T angle and cardiac troponin T concentration in psychiatric patients

et al. 2019

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BackgroundElectroconvulsive therapy (ECT) is an effective treatment method used in psychiatry; however, its cardiac safety has not been clearly demonstrated. The aim of the study was evaluation of the ECT effects on the myocardium based on troponin T concentrations and the following ECG parameters: the spatial QRS-T angle (QRS-TA), QRS duration (QRSd) and the corrected QT interval (QTc).MethodsIn the study 44 patients (12 female and 32 male) were enrolled diagnosed with schizophrenia (n = 21) and major depressive disorders (n = 23), according to the DSM-IVR criteria. All cases were undergoing ECT procedures. The mean age of the patients was 36.9±16 years (range: 18–74). Resting ECG was recorded before performing ECG and 1 hour after. The spatial QRS-TA was reconstructed from 12-lead ECG using the inverse Dower method. Troponin T concentration was assessed before the procedure and 6 hours after ECT.ResultsNo significant changes to troponin T concentrations were observed during the ECT series. The pre-ECT value of the spatial QRS-TA was 41.1±18.9°. The follow-up examinations did not reveal any significant increase of this parameter (p = 0.09) in any of the consecutive measurements. There were no significant changes in the QTc interval duration or the QRS complex duration demonstrated before the third, fifth and last procedure in the cycle (p>0.05). No significant changes to troponin T concentrations were observed during the ECT series.ConclusionsOur findings indicate a lack of negative ECT effects on the risk of adverse cardiovascular events measured by the spatial QRS-T angle and cardiac troponin T concentration.

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Medication management during electroconvulsant therapy

Cited by 35 publications

References 47 publications

Case report: delayed response after electroconvulsive therapy in a patient with major depressive disorder

Case report: delayed response after electroconvulsive therapy in a patient with major depressive disorder

General Anaesthesia Protocols for Patients Undergoing Electroconvulsive Therapy: Retrospective analysis of 504 sessions over a five-year period at a tertiary care hospital in Oman

The impact of electroconvulsive therapy on the spatial QRS-T angle and cardiac troponin T concentration in psychiatric patients

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