Promethazine for the treatment of agitation after electroconvulsive therapy: a case series.
OBJECTIVE
Agitation after electroconvulsive therapy (ECT) is observed in approximately 7% of patients. Promethazine is an antihistamine with sedative properties that has no antiseizure effects and therefore can be administered before ECT to prevent the onset of agitation. In the current study, we present a series of 8 patients who reacted to ECT with severe agitation and improved under the treatment of promethazine.


METHODS
Eight patients were included (5 women, 3 men), ages 22 to 77 years. All patients showed severe post-ECT agitation as demonstrated by severe restlessness, crying, or mumbling loudly. Seven of them required the administration of intravenous midazolam. ECT was given according to established clinical protocols at the Sheba Medical Center. All patients were prescribed either 25 to 50 mg of promethazine 2 hours before the treatment to avoid agitation.


RESULTS
All 8 patients suffered from extreme agitation after ECT treatment, and 7 required the administration of intravenous midazolam. After a clinical protocol, these patients were prescribed 25-50 mg of promethazine orally 60-120 minutes before the ECT. Improvement was observed in all patients both immediately post-ECT and also in their overall sense of well-being after the ECT. No patient complained of adverse reactions to the promethazine. Most patients reported a relief in pre-ECT fears.


CONCLUSIONS
In this small case series, we found that promethazine can be used to prevent post-ECT agitation. Further double-blind controlled studies are needed to better evaluate the usefulness and appropriateness of promethazine in the prevention of pre-ECT fears and post-ECT agitation.
Vishne
Tali
T
Division of Psychiatry Sheba Medical Center, Israel. tali@vishne.com
Amiaz
Revital
R
Grunhaus
Leon
L
D000328:Adult; D000368:Aged; D004334:Drug Administration Schedule; D004565:Electroconvulsive Therapy / Q000009:adverse effects*; D005260:Female; D006634:Histamine H1 Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D011398:Promethazine / Q000008:administration & dosage / Q000627:therapeutic use*; D011595:Psychomotor Agitation / Q000209:etiology* / Q000517:prevention & control*; D016896:Treatment Outcome
D006634:Histamine H1 Antagonists; D011398:Promethazine