The effects of diltiazem on hemodynamics and seizure duration during electroconvulsive therapy.
Electroconvulsive therapy (ECT) is often associated with acute hyperdynamic responses, and we hypothesize that diltiazem can blunt this response. We measured the effect of a 10-mg dose of diltiazem on heart rate and mean arterial pressure during ECT. Furthermore, we assessed seizure duration by using both the cuff method and two-lead electroencephalogram. We studied 18 patients with a randomized, double-blinded, placebo-controlled cross-over study design. Diltiazem significantly reduced heart rate and mean arterial pressure just after medication, and it also significantly reduced the increases in these variables after ECT, as compared with the placebo. The use of diltiazem was, however, associated with a shortened seizure duration, possibly making ECT less effective. Because of the reduction in seizure duration, the routine administration of diltiazem may not be advisable because it can possibly interfere with the psychotherapeutic efficacy of ECT. However, diltiazem medication for ECT is potentially useful for reducing tachycardia and hypertension in high-risk patients.


CONCLUSIONS
Diltiazem can blunt acute hyperdynamic responses after electroconvulsive therapy, but seizure duration is also significantly reduced, possibly making this therapy less effective.
Wajima
Z
Z
Department of Anesthesia, Chiba Hokusoh Hospital, Nippon Medical School, 1715, Kamagari, Inba-mura, Chiba 270-1694, Japan. HFB01245@nifty.ne.jp
Yoshikawa
T
T
Ogura
A
A
Imanaga
K
K
Shiga
T
T
Inoue
T
T
Ogawa
R
R
D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D018592:Cross-Over Studies; D004110:Diltiazem / Q000627:therapeutic use*; D004311:Double-Blind Method; D004565:Electroconvulsive Therapy / Q000009:adverse effects; D004569:Electroencephalography; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D012640:Seizures / Q000503:physiopathology*; D013610:Tachycardia / Q000209:etiology / Q000517:prevention & control
D002317:Cardiovascular Agents; D004110:Diltiazem