Influence of Anesthetic Drugs and Concurrent Psychiatric Medication on Seizure Adequacy During Electroconvulsive Therapy
J Clin Psychiatry 2010;71(6):775-777
© Copyright 2015 Physicians Postgraduate Press, Inc.
Purchase This PDF for $40.00
If you are not a paid subscriber, you may purchase the PDF.
(You'll need the free Adobe Acrobat Reader.)
Receive immediate full-text access to JCP. You can subscribe to JCP online-only ($86) or print + online ($156 individual).
With your subscription, receive a free PDF collection of the NCDEU Festschrift articles. Hurry! This offer ends December 31, 2011.
If you are a paid subscriber to JCP and do not yet have a username and password, activate your subscription now.
As a paid subscriber who has activated your subscription, you have access to the HTML and PDF versions of this item.
Click here to login.
Did you forget your password?
Still can't log in? Contact the Circulation Department at 1-800-489-1001 x4 or send email
Objective: Electroconvulsive therapy (ECT) is performed under anesthesia and muscle relaxation. Only well-generalized seizures seem to have the high “adequacy” or “quality” that have been claimed to reflect positive predictive power for the outcome of an ECT course. The induction of well-generalized seizures can be potentially influenced by several variables. One major variable is concurrent medication including anesthetic drugs, since most anesthetic drugs are potent anticonvulsives. We hypothesized a negative influence of anesthetics and benzodiazepines but a positive effect of antidepressants and antipsychotics concurrently applied during ECT on seizure adequacy.
Method: We included inpatients (n = 41)
with a DSM-IV–diagnosed major depressive episode treated with ECT (411 ECT sessions) during a period of 20 months (May 2005 to December 2006) in an open label and noncontrolled study. A repeated measurement regression analysis was performed with 8 seizure adequacy parameters as dependent variables. We indirectly quantified narcotic agent influence with bispectral index monitoring.
Results: In contrast to the impact of psychiatric comedication, this measure of “depth of narcosis” prior stimulation turned out to influence most seizure adequacy parameters in a highly significant manner.
Conclusions: Thus, we concluded that the anticonvulsive properties of narcotic agents have much higher influence than concomitant psychotropic medication. Our data support the view that a significant influence of concurrent psychotropic drugs on seizure adequacy markers is missing, especially when directly compared with other confounders like stimulation energy, age, and depth of narcosis. The latter suggests to further prove the idea that lighter anesthesia is indeed an important tool to
get patients faster into remission.
J Clin Psychiatry 2010;71(6):775–777
Submitted: December 20, 2008; accepted February 19, 2009.
Online ahead of print: December 29, 2009.
Corresponding author: Alexander Sartorius, MD, PhD, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, University of Heidelberg, Square J 5, D-68159 Mannheim, Germany (email@example.com).