This chapter reviews the evidence for the use of psychotropic medicines during and after ECT. There is limited research into the effects of psychotropic medication on ECT. Most patients will be taking medication during a course of ECT which may alter the length of seizure or the seizure threshold. The information in this chapter should be used in conjunction with other sources to make sure the most up-to-date information is followed.

Antipsychotics

The majority of papers in the literature on the use of antipsychotics with ECT involve typical antipsychotics. There have been some studies using atypical antipsychotics including clozapine, olanzapine and risperidone. One systematic review appraised 42 papers including 1371 patients. There were eight double-blind studies involved (Braga & Petrides, 2005). The typical antipsychotics studied were chlorpromazine, haloperidol, trifluoperazine, perphenazine, loxapine, flupentixol, fluphenazine and thiothixene. Most of the reports describe the combination of antipsychotic and ECT as safe or do not mention adverse effects of this combination. Clozapine can cause EEG abnormalities and can reduce the seizure threshold in a dose-dependent manner (Electronic Medicines Compendium, 2010). However, there are reports of clozapine being used successfully in combination with ECT without any serious problems (Braga & Petrides, 2005).

There is a case report of olanzapine being used in combination with duloxetine in a patient receiving ECT without any problems (Hanratta & Malek-Ahmadi, 2006).

There have been case reports of aripiprazole being used in combination with other psychotropic drugs (venlafaxine, levomepromazine, quetiapine, haloperidol and clozapine) in patients receiving ECT with minimal adverse effects (Masdrakis et al, 2008a; Lopez-Garcia et al, 2009).

A review of 11 Indian studies (Painuly & Chakrabarti, 2006) on the use of antipsychotics (chlorpromazine, haloperidol or trifluoperazine) with ECT reported few side-effects, which were minor and/or transient.

Northdurfter et al (2006) performed a retrospective study on the effect of antipsychotics on ECT. Of 5482 ECT treatments involving 455 patients, 452 ECT treatments used concomitant antipsychotics. Patients received unilateral or bilateral ECT and a variety of anaesthetic agents (thiopental, propofol, methohexital and etomidate). Suxamethonium, pyridostigmine and atracurium were used as muscle relaxants. Overall, 37% of ECT treatments were carried out with atypical antipsychotics, 17% with high-potency typical antipsychotics, 8% with medium-potency typicals and 37% with low-potency typicals. There were significant differences in seizure duration measured using EEG and electromyography. Use of low-potency antipsychotics was associated with significantly longer EEG seizures compared with no antipsychotic medication.