Augmentation strategies in electroconvulsive therapy.
Electroconvulsive therapy (ECT) is a highly effective treatment, but strategies to enhance therapeutic outcomes are occasionally needed. This review examines the evidence for approaches used for enhancing seizure production: hyperventilation, pretreatment with xanthines, and use of remifentanil or ketamine in ECT anesthesia. Hyperventilation may be a useful strategy to enhance seizure production, but its effects on ECT outcomes have not been systematically studied and require further research. Pretreatment with caffeine, theophylline or aminophylline (xanthines) prolongs the duration of ECT seizures but has not been clearly shown in controlled trials to increase efficacy. Caution is also warranted because their use may be associated with significant adverse effects. There are case reports of the usefulness of remifentanil in assisting seizure induction by reducing the dose of barbiturate anesthetic required, but there are no controlled data on whether it independently enhances efficacy outcomes. Preliminary evidence suggests that ketamine and ECT may have synergistic antidepressant effects, although this needs to be further examined in randomized controlled trials.
Loo
Colleen
C
School of Psychiatry, University of New South Wales, Sydney, Australia. colleen.loo@unsw.edu.au
Simpson
Brett
B
MacPherson
Ross
R
D002110:Caffeine / Q000627:therapeutic use; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004565:Electroconvulsive Therapy / Q000379:methods*; D018691:Excitatory Amino Acid Antagonists / Q000627:therapeutic use; D006801:Humans; D006985:Hyperventilation; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007649:Ketamine / Q000627:therapeutic use; D010880:Piperidines / Q000627:therapeutic use; D000077208:Remifentanil; D016896:Treatment Outcome
D000697:Central Nervous System Stimulants; D018691:Excitatory Amino Acid Antagonists; D006993:Hypnotics and Sedatives; D010880:Piperidines; D002110:Caffeine; D007649:Ketamine; D000077208:Remifentanil