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

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Abstract

Electroconvulsive therapy (ECT) is an effective treatment for severe psychiatric disorders. Patients referred to ECT are often taking multiple medications, many of which can potentially affect the safety and efficacy of their course of ECT. This review evaluates the impact of a variety of psychotropic medications often used in conjunction with ECT and examines strategies to optimize their management. The review encompasses mood stabilizers, antidepressants, benzodiazepines, antiepileptics, antipsychotics, and other commonly used psychotropics.

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References

  1. McDonald WM, Meeks TW, Carpenter LL, McCall WV, Zorumski CF. Electroconvulsive therapy and other neuromodulation therapies. In: Schatzberg AF, Nemeroff CB, editors. Textbook of psychopharmacology. 5th ed. Washington, DC: American Psychiatric Press; 2017. p. 861–899.

    Google Scholar 

  2. McDonald WM, Weiner RD, Fochtmann LJ, McCall WV. The FDA and ECT. J ECT. 2016;32(2):75–7. https://doi.org/10.1097/YCT.0000000000000326.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Hermida AP, Tang YL, Glass O, Janjua AU, McDonald WM. Efficacy and safety of ECT for behavioral and psychological symptoms of dementia (BPSD): a retrospective chart review. Am J Geriatr Psychiatry. 2020;28(2):157–63. https://doi.org/10.1016/j.jagp.2019.09.008.

    Article  PubMed  Google Scholar 

  4. The Practice of Electroconvulsive Therapy: Recommendations for treatment, training and privileging. Task Force Report of the American Psychiatric Association, 2nd ed. Washington, DC: American Psychiatric Association; 2001.

  5. Kellner CH, Greenberg RM, Murrough JW, Bryson EO, Briggs MC, Pasculli RM. ECT in treatment-resistant depression. Am J Psychiatry. 2012;169(12):1238–44. https://doi.org/10.1176/appi.ajp.2012.12050648.

    Article  PubMed  Google Scholar 

  6. Beale MD, Kellner CH. ECT in treatment algorithms: no need to save the best for last. J ECT. 2000;16(1):1–2.

    Article  CAS  Google Scholar 

  7. Canadian Agency for Drugs and Technologies in Health. Delivery of electroconvulsive therapy in non-hospital settings: a review of the safety and guidelines. Ottawa: Canadian Agency for Drugs and Technologies in Health; 2014.

    Google Scholar 

  8. Sato M, Hirota K, Shirakami G, Kakuyama M, Tanabe H, Fukuda K. Safety in general anesthesia for ambulatory electroconvulsive therapy (in Japanese). Masui. 2013;62(1):52–9.

    PubMed  Google Scholar 

  9. Reti IM, Walker M, Pulia K, Gallegos J, Jayaram G, Vaidya P. Safety considerations for outpatient electroconvulsive therapy. J Psychiatr Pract. 2012;18(2):130–6. https://doi.org/10.1097/01.pra.0000413280.95843.d3.

    Article  PubMed  Google Scholar 

  10. Sackeim HA, Decina P, Portnoy S, Neeley P, Malitz S. Studies of dosage, seizure threshold, and seizure duration in ECT. Biol Psychiatry. 1987;22(3):249–68.

    Article  CAS  Google Scholar 

  11. Sackeim HA, Prudic J, Devanand DP, Nobler MS, Lisanby SH, Peyser S, et al. A prospective, randomized, double-blind comparison of bilateral and right unilateral electroconvulsive therapy at different stimulus intensities. Arch Gen Psychiatry. 2000;57(5):425–34.

    Article  CAS  Google Scholar 

  12. Boylan LS, Haskett RF, Mulsant BH, Greenberg RM, Prudic J, Spicknall K, et al. Determinants of seizure threshold in ECT: benzodiazepine use, anesthetic dosage, and other factors. J ECT. 2000;16(1):3–18. https://doi.org/10.1097/00124509-200003000-00002.

    Article  CAS  PubMed  Google Scholar 

  13. Galvez V, Hadzi-Pavlovic D, Smith D, Loo CK. Predictors of seizure threshold in right unilateral ultrabrief electroconvulsive therapy: role of concomitant medications and anaesthesia used. Brain Stimul. 2015;8(3):486–92. https://doi.org/10.1016/j.brs.2014.12.012.

    Article  PubMed  Google Scholar 

  14. Sackeim HA, Luber B, Katzman GP, Moeller JR, Prudic J, Devanand DP, et al. The effects of electroconvulsive therapy on quantitative electroencephalograms. Relationship to clinical outcome. Arch Gen Psychiatry. 1996;53(9):814–24.

    Article  CAS  Google Scholar 

  15. Sackeim HA, Devanand DP, Prudic J. Stimulus intensity, seizure threshold, and seizure duration: impact on the efficacy and safety of electroconvulsive therapy. Psychiatr Clin N Am. 1991;14(4):803–43.

    Article  CAS  Google Scholar 

  16. Ottosson JO. Seizure characteristics and therapeutic efficency in electroconvusive therapy: an analysis of the antidepressant efficiency of grand mal and lidocaine-modified seizures. J Nerv Ment Dis. 1962;135:239–51.

    Article  CAS  Google Scholar 

  17. Fink M. The seizure, not electricity, is essential in convulsive therapy: the flurothyl experience. J ECT. 2014;30(2):91–3. https://doi.org/10.1097/yct.0000000000000110.

    Article  CAS  PubMed  Google Scholar 

  18. Bost-Baxter E, Reti I, Payne J. ECT in bipolar disorder: incidence of switch from depression to hypomania or mania. J Depress Anxiety. 2012;1:1–4.

    Google Scholar 

  19. Angst J, Angst K, Baruffol I, Meinherz-Surbeck R. ECT-induced and drug-induced hypomania. Convuls Ther. 1992;8(3):179–85.

    PubMed  Google Scholar 

  20. Medda P, Toni C, Perugi G. The mood-stabilizing effects of electroconvulsive therapy. J ECT. 2014;30(4):275–82. https://doi.org/10.1097/yct.0000000000000160.

    Article  CAS  PubMed  Google Scholar 

  21. Perugi G, Medda P, Toni C, Mariani MG, Socci C, Mauri M. The role of electroconvulsive therapy (ECT) in bipolar disorder: effectiveness in 522 patients with bipolar depression, mixed-state, mania and catatonic features. Curr Neuropharmacol. 2017;15(3):359–71. https://doi.org/10.2174/1570159x14666161017233642.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Chiao S, Isenberg K, North CS. Psychotropic medication effects on seizure threshold and seizure duration during electroconvulsive therapy stimulus titration. J ECT. 2019. https://doi.org/10.1097/yct.0000000000000621.

    Article  PubMed  Google Scholar 

  23. van Waarde JA, van Oudheusden LJ, Verwey B, Giltay EJ, van der Mast RC. Clinical predictors of seizure threshold in electroconvulsive therapy: a prospective study. Eur Arch Psychiatry Clin Neurosci. 2013;263(2):167–75. https://doi.org/10.1007/s00406-012-0342-7.

    Article  PubMed  Google Scholar 

  24. Virupaksha HS, Shashidhara B, Thirthalli J, Kumar CN, Gangadhar BN. Comparison of electroconvulsive therapy (ECT) with or without anti-epileptic drugs in bipolar disorder. J Affect Disord. 2010;127(1–3):66–70. https://doi.org/10.1016/j.jad.2010.05.008.

    Article  PubMed  Google Scholar 

  25. Jahangard L, Haghighi M, Bigdelou G, Bajoghli H, Brand S. Comparing efficacy of ECT with and without concurrent sodium valproate therapy in manic patients. J ECT. 2012;28(2):118–23. https://doi.org/10.1097/YCT.0b013e31824b64b5.

    Article  CAS  PubMed  Google Scholar 

  26. Rakesh G, Thirthalli J, Kumar CN, Muralidharan K, Phutane VH, Gangadhar BN. Concomitant anticonvulsants with bitemporal electroconvulsive therapy: a randomized controlled trial with clinical and neurobiological application. J ECT. 2017;33(1):16–211. https://doi.org/10.1097/yct.0000000000000357.

    Article  PubMed  Google Scholar 

  27. Penland HR, Ostroff RB. Combined use of lamotrigine and electroconvulsive therapy in bipolar depression: a case series. J ECT. 2006;22(2):142–7.

    Article  Google Scholar 

  28. Sienaert P, Roelens Y, Demunter H, Vansteelandt K, Peuskens J, Van Heeringen C. Concurrent use of lamotrigine and electroconvulsive therapy. J ECT. 2011;27(2):148–52. https://doi.org/10.1097/YCT.0b013e3181e63318.

    Article  CAS  PubMed  Google Scholar 

  29. Joo SW, Joo YH, Kim CY, Lee JS. Effects of stimulus parameters on motor seizure duration in electroconvulsive therapy. Neuropsychiatr Dis Treat. 2017;13:1427–34. https://doi.org/10.2147/ndt.S134503.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Pettinati HM, Stephens SM, Willis KM, Robin SE. Evidence for less improvement in depression in patients taking benzodiazepines during unilateral ECT. Am J Psychiatry. 1990;147(8):1029–35. https://doi.org/10.1176/ajp.147.8.1029.

    Article  CAS  PubMed  Google Scholar 

  31. Bailine SH, Safferman A, Vital-Herne J, Bernstein S. Flumazenil reversal of benzodiazepine-induced sedation for a patient with severe pre-ECT anxiety. Convuls Ther. 1994;10(1):65–8.

    CAS  PubMed  Google Scholar 

  32. Krystal AD, Watts BV, Weiner RD, Moore S, Steffens DC, Lindahl V. The use of flumazenil in the anxious and benzodiazepine-dependent ECT patient. J ECT. 1998;14(1):5–14.

    Article  CAS  Google Scholar 

  33. Galvez V, Loo CK, Alonzo A, Cerrillo E, Menchon JM, Crespo JM, et al. Do benzodiazepines moderate the effectiveness of bitemporal electroconvulsive therapy in major depression? J Affect Disord. 2013;150(2):686–90. https://doi.org/10.1016/j.jad.2013.03.028.

    Article  CAS  PubMed  Google Scholar 

  34. Jha A, Stein G. Decreased efficacy of combined benzodiazepines and unilateral ECT in treatment of depression. Acta Psychiatr Scand. 1996;94(2):101–4. https://doi.org/10.1111/j.1600-0447.1996.tb09832.x.

    Article  CAS  PubMed  Google Scholar 

  35. Delamarre L, Galvao F, Gohier B, Poulet E, Brunelin J. How much do benzodiazepines matter for electroconvulsive therapy in patients with major depression? J ECT. 2019;35(3):184–8. https://doi.org/10.1097/yct.0000000000000574.

    Article  CAS  PubMed  Google Scholar 

  36. Greenberg RM, Pettinati HM. Benzodiazepines and electroconvulsive therapy. Convuls Ther. 1993;9(4):262–73.

    PubMed  Google Scholar 

  37. Sackeim HA, Prudic J, Devanand DP, Decina P, Kerr B, Malitz S. The impact of medication resistance and continuation pharmacotherapy on relapse following response to electroconvulsive therapy in major depression. J Clin Psychopharmacol. 1990;10(2):96–104.

    Article  CAS  Google Scholar 

  38. Petrides G, Fink M, Husain MM, Knapp RG, Rush AJ, Mueller M, et al. ECT remission rates in psychotic versus nonpsychotic depressed patients: a report from CORE. J ECT. 2001;17(4):244–53.

    Article  CAS  Google Scholar 

  39. Chanpattana W, Sackeim HA. Electroconvulsive therapy in treatment-resistant schizophrenia: prediction of response and the nature of symptomatic improvement. J ECT. 2010;26(4):289–98. https://doi.org/10.1097/YCT.0b013e3181cb5e0f.

    Article  PubMed  Google Scholar 

  40. Zervas IM, Theleritis C, Soldatos CR. Using ECT in schizophrenia: a review from a clinical perspective. World J Biol Psychiatry. 2012;13(2):96–105. https://doi.org/10.3109/15622975.2011.564653.

    Article  PubMed  Google Scholar 

  41. Tang YL, Jiang W, Ren YP, Ma X, Cotes RO, McDonald WM. Electroconvulsive therapy in China: clinical practice and research on efficacy. J ECT. 2012;28(4):206–12. https://doi.org/10.1097/YCT.0b013e31825957b1.

    Article  PubMed  Google Scholar 

  42. Petrides G, Malur C, Braga RJ, Bailine SH, Schooler NR, Malhotra AK, et al. Electroconvulsive therapy augmentation in clozapine-resistant schizophrenia: a prospective, randomized study. Am J Psychiatry. 2015;172(1):52–8. https://doi.org/10.1176/appi.ajp.2014.13060787.

    Article  PubMed  Google Scholar 

  43. Tharyan P, Adams CE. Electroconvulsive therapy for schizophrenia. Cochrane Database Syst Rev. 2005;2:CD000076. https://doi.org/10.1002/14651858.CD000076.pub2.

    Article  Google Scholar 

  44. Lin HT, Liu SK, Hsieh MH, Chien YL, Chen IM, Liao SC, et al. Impacts of electroconvulsive therapy on 1-year outcomes in patients with schizophrenia: a controlled, population-based mirror-image study. Schizophr Bull. 2018;44(4):798–806. https://doi.org/10.1093/schbul/sbx136.

    Article  PubMed  Google Scholar 

  45. Sinclair DJ, Zhao S, Qi F, Nyakyoma K, Kwong JS, Adams CE. Electroconvulsive therapy for treatment-resistant schizophrenia. Cochrane Database Syst Rev. 2019;3:CD011847. https://doi.org/10.1002/14651858.CD011847.pub2.

    Article  PubMed  Google Scholar 

  46. Ahmed S, Khan AM, Mekala HM, Venigalla H, Ahmed R, Etman A, et al. Combined use of electroconvulsive therapy and antipsychotics (both clozapine and non-clozapine) in treatment resistant schizophrenia: a comparative meta-analysis. Heliyon. 2017;3(11):e00429. https://doi.org/10.1016/j.heliyon.2017.e00429.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Pawelczyk T, Kolodziej-Kowalska E, Pawelczyk A, Rabe-Jablonska J. Augmentation of antipsychotics with electroconvulsive therapy in treatment-resistant schizophrenia patients with dominant negative symptoms: a pilot study of effectiveness. Neuropsychobiology. 2014;70(3):158–64. https://doi.org/10.1159/000366484.

    Article  CAS  PubMed  Google Scholar 

  48. Zheng W, Cao XL, Ungvari GS, Xiang YQ, Guo T, Liu ZR, et al. Electroconvulsive therapy added to non-clozapine antipsychotic medication for treatment resistant schizophrenia: meta-analysis of randomized controlled trials. PLoS ONE. 2016;11(6):e0156510. https://doi.org/10.1371/journal.pone.0156510.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Grover S, Hazari N, Kate N. Combined use of clozapine and ECT: a review. Acta Neuropsychiatr. 2015;27(3):131–42. https://doi.org/10.1017/neu.2015.8.

    Article  PubMed  Google Scholar 

  50. Kupchik M, Spivak B, Mester R, Reznik I, Gonen N, Weizman A, et al. Combined electroconvulsive-clozapine therapy. Clin Neuropharmacol. 2000;23(1):14–6.

    Article  CAS  Google Scholar 

  51. Jelovac A, Kolshus E, McLoughlin DM. Relapse following successful electroconvulsive therapy for major depression: a meta-analysis. Neuropsychopharmacology. 2013;38(12):2467–74. https://doi.org/10.1038/npp.2013.149.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Prudic J, Haskett RF, McCall WV, Isenberg K, Cooper T, Rosenquist PB, et al. Pharmacological strategies in the prevention of relapse after electroconvulsive therapy. J ECT. 2013;29(1):3–12. https://doi.org/10.1097/YCT.0b013e31826ea8c4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Seager CP, Bird RL. Imipramine with electrical treatment in depression: a controlled trial. J Ment Sci. 1962;108:704–7. https://doi.org/10.1192/bjp.108.456.704.

    Article  CAS  PubMed  Google Scholar 

  54. Monaco JT, Delaplaine P. Tranylcypromine with ECT. Am J Psychiatry. 1964;120:1003. https://doi.org/10.1176/ajp.120.10.1003.

    Article  CAS  PubMed  Google Scholar 

  55. Kay DW, Fahy T, Garside RF. A seven-month double-blind trial of amitriptyline and diazepam in ECT-treated depressed patients. Br J Psychiatry. 1970;117(541):667–71. https://doi.org/10.1192/bjp.117.541.667.

    Article  CAS  PubMed  Google Scholar 

  56. Sackeim HA, Haskett RF, Mulsant BH, Thase ME, Mann JJ, Pettinati HM, et al. Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial. JAMA. 2001;285(10):1299–307.

    Article  CAS  Google Scholar 

  57. Nelson JP, Benjamin L. Efficacy and safety of combined ECT and tricyclic antidepressant therapy in the treatment of depressed geriatric patients. Convuls Ther. 1989;5:321–9.

    PubMed  Google Scholar 

  58. Sackeim HA, Dillingham EM, Prudic J, Cooper T, McCall WV, Rosenquist P, et al. Effect of concomitant pharmacotherapy on electroconvulsive therapy outcomes: short-term efficacy and adverse effects. Arch Gen Psychiatry. 2009;66(7):729–37. https://doi.org/10.1001/archgenpsychiatry.2009.75.

    Article  CAS  PubMed  Google Scholar 

  59. Kellner CH, Knapp RG, Petrides G, Rummans TA, Husain MM, Rasmussen K, et al. Continuation electroconvulsive therapy vs pharmacotherapy for relapse prevention in major depression: a multisite study from the Consortium for Research in Electroconvulsive Therapy (CORE). Arch Gen Psychiatry. 2006;63(12):1337–444. https://doi.org/10.1001/archpsyc.63.12.1337.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Kellner CH, Husain MM, Knapp RG, McCall WV, Petrides G, Rudorfer MV, et al. A novel strategy for continuation ECT in geriatric depression: phase 2 of the PRIDE study. Am J Psychiatry. 2016;173(11):1110–8. https://doi.org/10.1176/appi.ajp.2016.16010118.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Dolenc TJ, Habl SS, Barnes RD, Rasmussen KG. Electroconvulsive therapy in patients taking monoamine oxidase inhibitors. J ECT. 2004;20(4):258–61.

    Article  Google Scholar 

  62. Muller D. 1. Nardil (phenelzine) as a potentiator of electroconvulsive therapy (E.C.T.) 2. A survey of outpatient E.C.T. J Ment Sci. 1961;107:994–6. https://doi.org/10.1192/bjp.107.451.994.

    Article  CAS  PubMed  Google Scholar 

  63. Baghai TC, Marcuse A, Brosch M, Schule C, Eser D, Nothdurfter C, et al. The influence of concomitant antidepressant medication on safety, tolerability and clinical effectiveness of electroconvulsive therapy. World J Biol Psychiatry. 2006;7(2):82–90. https://doi.org/10.1080/15622970500213871.

    Article  PubMed  Google Scholar 

  64. Krystal AD, Weiner RD. ECT seizure therapeutic adequacy. Convuls Ther. 1994;10(2):153–64.

    CAS  PubMed  Google Scholar 

  65. Krystal AD, Weiner RD, Coffey CE. The ictal EEG as a marker of adequate stimulus intensity with unilateral ECT. J Neuropsychiatry Clin Neurosci. 1995;7(3):295–303.

    Article  CAS  Google Scholar 

  66. Lauritzen L. Relapse prevention by means of paroxetine in ECT-treated patients with major depression: a comparison with imipramine and placebo in medium-term continuation therapy. Acta Psychiatr Scand. 1996;94(4):241–51.

    Article  CAS  Google Scholar 

  67. Gonzalez-Pinto A, Gutierrez M, Gonzalez N, Elizagarate E, de Heredia PJL, Mico JA. Efficacy and safety of venlafaxine-ECT combination in treatment-resistant depression. J Neuropsychiatry Clin Neurosci. 2002;14(2):206–9.

    Article  CAS  Google Scholar 

  68. Doellinger OV, Ribeiro JP, Ribeiro A, Freitas C, Ribeiro B, Silva JC. Spontaneous seizures after ECT in a patient medicated with bupropion, sertraline and risperidone. Trends Psychiatry Psychother. 2016;38(2):111–3. https://doi.org/10.1590/2237-6089-2015-0055.

    Article  Google Scholar 

  69. Dersch R, Zwernemann S, Voderholzer U. Partial status epilepticus after electroconvulsive therapy and medical treatment with bupropion. Pharmacopsychiatry. 2011;44(7):344–6. https://doi.org/10.1055/s-0031-1284425.

    Article  CAS  PubMed  Google Scholar 

  70. Conway CR, Nelson LA. The combined use of bupropion, lithium, and venlafaxine during ECT: a case of prolonged seizure activity. J ECT. 2001;17(3):216–8.

    Article  CAS  Google Scholar 

  71. Takala CR, Leung JG, Murphy LL, Geske JR, Palmer BA. Concurrent electroconvulsive therapy and bupropion treatment. J ECT. 2017;33(3):185–9. https://doi.org/10.1097/yct.0000000000000423.

    Article  CAS  PubMed  Google Scholar 

  72. Johannessen Landmark C, Henning O, Johannessen SI. Proconvulsant effects of antidepressants: what is the current evidence? Epilepsy Behav. 2016;61:287–91. https://doi.org/10.1016/j.yebeh.2016.01.029.

    Article  PubMed  Google Scholar 

  73. Rudorfer MV, Manji HK, Potter WZ. Bupropion, ECT, and dopaminergic overdrive. Am J Psychiatry. 1991;148(8):1101–2.

    Article  CAS  Google Scholar 

  74. Rudorfer MV, Linnoila M, Potter WZ. Combined lithium and electroconvulsive therapy: pharmacokinetic and pharmacodynamic interactions. Convuls Ther. 1987;3(1):40–5.

    PubMed  Google Scholar 

  75. Hoenig J, Chaulk R. Delirium associated with lithium therapy and electroconvulsive therapy. Can Med Assoc J. 1977;116(8):837–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  76. DePaulo JR Jr, Folstein MF, Correa EI. The course of delirium due to lithium intoxication. J Clin Psychiatry. 1982;43(11):447–9.

    PubMed  Google Scholar 

  77. Ahmed SK, Stein GS. Negative interaction between lithium and ECT. Br J Psychiatry. 1987;151:419–20. https://doi.org/10.1192/bjp.151.3.419.

    Article  CAS  PubMed  Google Scholar 

  78. Hill GE, Wong KC, Hodges MR. Potentiation of succinylcholine neuromuscular blockade by lithium carbonate. Anesthesiology. 1976;44(5):439–42. https://doi.org/10.1097/00000542-197605000-00019.

    Article  CAS  PubMed  Google Scholar 

  79. Jephcott GKR. Lithium: an anaesthetic risk. Br J Anaesth. 1974;46:389–90.

    Article  CAS  Google Scholar 

  80. Borden H, Clarke MT, Katz H. The use of pancuronium bromide in patients receiving lithium carbonate. Can Anaesth Soc J. 1974;21(1):79–82. https://doi.org/10.1007/bf03004581.

    Article  CAS  PubMed  Google Scholar 

  81. Weiner RD, Whanger AD, Erwin CW, Wilson WP. Prolonged confusional state and EEG seizure activity following concurrent ECT and lithium use. Am J Psychiatry. 1980;137(11):1452–3. https://doi.org/10.1176/ajp.137.11.1452.

    Article  CAS  PubMed  Google Scholar 

  82. Peterson GN. Consensus on electroconvulsive therapy. JAMA. 1986;255(15):2023. https://doi.org/10.1001/jama.1986.03370150065014.

    Article  Google Scholar 

  83. Coppen A, Abou-Saleh MT, Milln P, Bailey J, Metcalfe M, Burns BH, et al. Lithium continuation therapy following electroconvulsive therapy. Br J Psychiatry. 1981;139:284–7. https://doi.org/10.1192/bjp.139.4.284.

    Article  CAS  PubMed  Google Scholar 

  84. Perry P, Tsuang MT. Treatment of unipolar depression following electroconvulsive therapy. Relapse rate comparisons between lithium and tricyclics therapies following ECT. J Affect Disord. 1979;1(2):123–9. https://doi.org/10.1016/0165-0327(79)90031-4.

    Article  CAS  PubMed  Google Scholar 

  85. Atiku L, Gorst-Unsworth C, Khan BU, Huq F, Gordon J. Improving relapse prevention after successful electroconvulsive therapy for patients with severe depression: completed audit cycle involving 102 full electroconvulsive therapy courses in West Sussex, United Kingdom. J ECT. 2015;31(1):34–6. https://doi.org/10.1097/yct.0000000000000164.

    Article  PubMed  Google Scholar 

  86. Brus O, Cao Y, Hammar A, Landen M, Lundberg J, Nordanskog P, et al. Lithium for suicide and readmission prevention after electroconvulsive therapy for unipolar depression: population-based register study. BJPsych Open. 2019;5(3):e46. https://doi.org/10.1192/bjo.2019.37.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Dolenc TJ, Rasmussen KG. The safety of electroconvulsive therapy and lithium in combination: a case series and review of the literature. J ECT. 2005;21(3):165–70.

    Article  CAS  Google Scholar 

  88. Tsujii T, Uchida T, Suzuki T, Mimura M, Hirano J, Uchida H. Factors associated with delirium following electroconvulsive therapy: a systematic review. J ECT. 2019;35(4):279–87. https://doi.org/10.1097/yct.0000000000000606.

    Article  PubMed  Google Scholar 

  89. Thirthalli J, Harish T, Gangadhar BN. A prospective comparative study of interaction between lithium and modified electroconvulsive therapy. World J Biol Psychiatry. 2011;12(2):149–55. https://doi.org/10.3109/15622975.2010.504860.

    Article  PubMed  Google Scholar 

  90. Patel RS, Bachu A, Youssef NA. Combination of lithium and electroconvulsive therapy (ECT) is associated with higher odds of delirium and cognitive problems in a large national sample across the United States. Brain Stimul. 2020;13(1):15–9. https://doi.org/10.1016/j.brs.2019.08.012.

    Article  PubMed  Google Scholar 

  91. Zolezzi M. Medication management during electroconvulsant therapy. Neuropsychiatr Dis Treat. 2016;12:931–9. https://doi.org/10.2147/ndt.S100908.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  92. Malhi GS, Byrow Y, Bassett D, Boyce P, Hopwood M, Lyndon W, et al. Stimulants for depression: on the up and up? Aust N Z J Psychiatry. 2016;50(3):203–7. https://doi.org/10.1177/0004867416634208.

    Article  PubMed  Google Scholar 

  93. Naguib M, Koorn R. Interactions between psychotropics, anaesthetics and electroconvulsive therapy: implications for drug choice and patient management. CNS Drugs. 2002;16(4):229–47.

    Article  CAS  Google Scholar 

  94. Pigot M, Andrade C, Loo C. Pharmacological attenuation of electroconvulsive therapy—induced cognitive deficits: theoretical background and clinical findings. J ECT. 2008;24(1):57–67. https://doi.org/10.1097/YCT.0b013e3181616c14.

    Article  CAS  PubMed  Google Scholar 

  95. Boman B. Concurrent use of ECT and cholinesterase inhibitor medications. Aust N Z J Psychiatry. 2002;36(6):816. https://doi.org/10.1046/j.1440-1614.2002.t01-5-01101a.x.

    Article  PubMed  Google Scholar 

  96. Bhat RS, Mayur P, Chakrabarti I. ECT-donepezil interaction: a single case report. Int J Geriatr Psychiatry. 2004;19(6):594–5. https://doi.org/10.1002/gps.1085.

    Article  PubMed  Google Scholar 

  97. Henstra MJ, Jansma EP, van der Velde N, Swart EL, Stek ML, Rhebergen D. Acetylcholinesterase inhibitors for electroconvulsive therapy-induced cognitive side effects: a systematic review. Int J Geriatr Psychiatry. 2017;32(5):522–31. https://doi.org/10.1002/gps.4702.

    Article  PubMed  Google Scholar 

  98. Rao NP, Palaniyappan P, Chandur J, Venkatasubramanian G, Gangadhar BN. Successful use of donepezil in treatment of cognitive impairment caused by maintenance electroconvulsive therapy: a case report. J ECT. 2009;25(3):216–8. https://doi.org/10.1097/YCT.0b013e3181926ada.

    Article  PubMed  Google Scholar 

  99. Prakash J, Kotwal A, Prabhu H. Therapeutic and prophylactic utility of the memory-enhancing drug donepezil hydrochloride on cognition of patients undergoing electroconvulsive therapy: a randomized controlled trial. J ECT. 2006;22(3):163–8. https://doi.org/10.1097/01.yct.0000230365.81368.2d.

    Article  CAS  PubMed  Google Scholar 

  100. Logan CJ, Stewart JT. Treatment of post-electroconvulsive therapy delirium and agitation with donepezil. J ECT. 2007;23(1):28–9. https://doi.org/10.1097/01.yct.0000263259.29291.c4.

    Article  PubMed  Google Scholar 

  101. Takamiya A, Sawada K, Hirano J, Mimura M, Kishimoto T. Prolonged post-electroconvulsive therapy delirium controlled with donepezil. J ECT. 2019;35(3):e29–e30. https://doi.org/10.1097/yct.0000000000000590.

    Article  PubMed  Google Scholar 

  102. Newport DJ, Carpenter LL, McDonald WM, Potash JB, Tohen M, Nemeroff CB. Ketamine and other NMDA antagonists: early clinical trials and possible mechanisms in depression. Am J Psychiatry. 2015;172(10):950–66. https://doi.org/10.1176/appi.ajp.2015.15040465.

    Article  PubMed  Google Scholar 

  103. Xu Y, Hackett M, Carter G, Loo C, Galvez V, Glozier N, et al. Effects of low-dose and very low-dose ketamine among patients with major depression: a systematic review and meta-analysis. Int J Neuropsychopharmacol. 2016;19(4):1. https://doi.org/10.1093/ijnp/pyv124.

    Article  Google Scholar 

  104. Rudolph U, Antkowiak B. Molecular and neuronal substrates for general anaesthetics. Nat Rev Neurosci. 2004;5(9):709–20. https://doi.org/10.1038/nrn1496.

    Article  CAS  PubMed  Google Scholar 

  105. Modica PA, Tempelhoff R, White PF. Pro- and anticonvulsant effects of anesthetics (Part II). Anesth Analg. 1990;70(4):433–44. https://doi.org/10.1213/00000539-199004000-00016.

    Article  CAS  PubMed  Google Scholar 

  106. Hoyer C, Kranaster L, Janke C, Sartorius A. Impact of the anesthetic agents ketamine, etomidate, thiopental, and propofol on seizure parameters and seizure quality in electroconvulsive therapy: a retrospective study. Eur Arch Psychiatry Clin Neurosci. 2014;264(3):255–61. https://doi.org/10.1007/s00406-013-0420-5.

    Article  PubMed  Google Scholar 

  107. Rasmussen KG, Ritter MJ. Some considerations of the tolerability of ketamine for ECT anesthesia: a case series and review of the literature. J ECT. 2014;30(4):283–6. https://doi.org/10.1097/yct.0000000000000100.

    Article  CAS  PubMed  Google Scholar 

  108. Anderson IM, Blamire A, Branton T, Clark R, Downey D, Dunn G, et al. Ketamine augmentation of electroconvulsive therapy to improve neuropsychological and clinical outcomes in depression (Ketamine-ECT): a multicentre, double-blind, randomised, parallel-group, superiority trial. Lancet Psychiatry. 2017;4(5):365–77. https://doi.org/10.1016/s2215-0366(17)30077-9.

    Article  PubMed  PubMed Central  Google Scholar 

  109. Abdallah CG, Fasula M, Kelmendi B, Sanacora G, Ostroff R. Rapid antidepressant effect of ketamine in the electroconvulsive therapy setting. J ECT. 2012;28(3):157–61. https://doi.org/10.1097/YCT.0b013e31824f8296.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  110. Loo CK, Katalinic N, Garfield JB, Sainsbury K, Hadzi-Pavlovic D, Mac-Pherson R. Neuropsychological and mood effects of ketamine in electroconvulsive therapy: a randomised controlled trial. J Affect Disord. 2012;142(1–3):233–40. https://doi.org/10.1016/j.jad.2012.04.032.

    Article  CAS  PubMed  Google Scholar 

  111. Rasmussen KG, Kung S, Lapid MI, Oesterle TS, Geske JR, Nuttall GA, et al. A randomized comparison of ketamine versus methohexital anesthesia in electroconvulsive therapy. Psychiatry Res. 2014;215(2):362–5. https://doi.org/10.1016/j.psychres.2013.12.027.

    Article  CAS  PubMed  Google Scholar 

  112. Yoosefi A, Sepehri AS, Kargar M, Akhondzadeh S, Sadeghi M, Rafei A, et al. Comparing effects of ketamine and thiopental administration during electroconvulsive therapy in patients with major depressive disorder: a randomized, double-blind study. J ECT. 2014;30(1):15–211. https://doi.org/10.1097/YCT.0b013e3182a4b4c6.

    Article  CAS  PubMed  Google Scholar 

  113. Zheng W, Li XH, Zhu XM, Cai DB, Yang XH, Ungvari GS, et al. Adjunctive ketamine and electroconvulsive therapy for major depressive disorder: a meta-analysis of randomized controlled trials. J Affect Disord. 2019;250:123–31. https://doi.org/10.1016/j.jad.2019.02.044.

    Article  CAS  PubMed  Google Scholar 

  114. Galvez V, McGuirk L, Loo CK. The use of ketamine in ECT anaesthesia: a systematic review and critical commentary on efficacy, cognitive, safety and seizure outcomes. World J Biol Psychiatry. 2017;18(6):424–44. https://doi.org/10.1080/15622975.2016.1252464.

    Article  PubMed  Google Scholar 

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Acknowledgements

The work in this paper was supported by the J.B. Fuqua Foundation.

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive, NE, Atlanta, GA, 30329, USA

    A. Umair Janjua, Amitha L. Dhingra & William M. McDonald

  2. Robert Wood Johnson School of Medicine, New Brunswick, NJ, USA

    Robert Greenberg

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  1. A. Umair Janjua
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  2. Amitha L. Dhingra
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  3. Robert Greenberg
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Correspondence to A. Umair Janjua.

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Conflict of interest

William M. McDonald has research contracts from Stanley Foundation, Soterix, Neuronetics, NeoSync, and Cervel Neurotherapeutics. He is an ad hoc member of several National Institute of Mental Health (NIMH) and National Institute of Neurological Disorders and Stroke (NINDS) study sections; is a member of the American Psychiatric Association (APA) Council on Research and Quality representing ECT and Neuromodulation Therapies; receives royalties from Oxford University Press to co-edit a book titled ‘Clinical Guide to Transcranial Magnetic Stimulation in the Treatment of Depression’; is a paid consultant for Signant Health; and is an employee of Emory University School of Medicine. A. Umair Janjua, Amitha L. Dhingra, and Robert Greenberg declare they have no conflicts of interest.

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Janjua, A.U., Dhingra, A.L., Greenberg, R. et al. The Efficacy and Safety of Concomitant Psychotropic Medication and Electroconvulsive Therapy (ECT). CNS Drugs 34, 509–520 (2020). https://doi.org/10.1007/s40263-020-00729-1

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