title: Beta-blocking agents during electroconvulsive therapy: a review.
abstract: Electroconvulsive therapy (ECT) is associated with at least transient episodes of hypertension and tachycardia. Beta-blocking agents may be indicated to prevent cardiovascular complications and may shorten seizure duration. This review evaluates studies that used beta-blocking agents during ECT to determine which agent has the most favourable outcomes on cardiovascular variables and seizure duration. A Medline database search was made using the combined keywords 'adrenergic beta-antagonists' and 'electroconvulsive therapy'. The search was restricted to double-blind randomized controlled trials and yielded 29 original studies. With the use of esmolol, significant attenuating effects were found on cardiovascular parameters in the first 5 min after stimulation; its shortening effects on seizure duration may be dose-related. With the use of labetalol, findings on cardiovascular effects were inconsistent during the first minutes after stimulation but were significant after 5 min and thereafter; seizure duration was scarcely studied. Landiolol attenuates heart rate but with inconsistent findings regarding arterial pressure (AP); seizure duration was mostly unaffected. Esmolol appears to be effective in reducing the cardiovascular response, although seizure duration may be affected with higher dosages. Landiolol can be considered a suitable alternative, but effects on AP need further investigation. Labetalol has been studied to a lesser extent and may have prolonged cardiovascular effects. The included studies varied in design, methodology, and the amount of exact data provided in the publications. Further study of beta-blocking agents in ECT is clearly necessary.
authors.affiliation: Department of Psychiatry, Erasmus Medical Centre, PO Box 2040, Rotterdam 3000 CA, The Netherlands e.boere@yahoo.com.
authors.forename: E
authors.initials: E
authors.lastname: Boere
authors.affiliation: Department of Psychiatry, Erasmus Medical Centre, PO Box 2040, Rotterdam 3000 CA, The Netherlands.
authors.forename: T K
authors.initials: TK
authors.lastname: Birkenhäger
authors.affiliation: Department of Anaesthesiology, Erasmus Medical Centre, PO Box 2040, Rotterdam 3000 CA, The Netherlands.
authors.forename: T H N
authors.initials: TH
authors.lastname: Groenland
authors.affiliation: Department of Psychiatry, Erasmus Medical Centre, PO Box 2040, Rotterdam 3000 CA, The Netherlands.
authors.forename: W W
authors.initials: WW
authors.lastname: van den Broek
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D004565:Electroconvulsive Therapy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007741:Labetalol / Q000627:therapeutic use; D009025:Morpholines / Q000627:therapeutic use; D011412:Propanolamines / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D014508:Urea / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000319:Adrenergic beta-Antagonists; D009025:Morpholines; D011412:Propanolamines; C077049:landiolol; D014508:Urea; C036604:esmolol; D007741:Labetalol
keywords: adrenergic beta-antagonists; electroconvulsive therapy; esmolol; labetalol; landiolol