Beta-Blocking Agents and Electroconvulsive Therapy

Walter   W.   van den Broek; Theo   H.N.   Groenland; Paul   G.H.   Mulder; Ari      Kusuma; Tom   K.   Birkenhager; Esther      Pluijms; Jan   A.   Bruijn

Abstract

In this review we want to summarize the results of the placebo-controlled randomized clinical trials with betablocking adrenergic agents during electroconvulsive therapy (ECT), and review the effect on seizure duration and cardiovascular variables. We searched for studies in the electronic databases Medline. Keywords combined in the search were: “beta-adrenergic blocking agents” and “electroconvulsive therapy”. The only limitation specified in the search was that the publications should include only randomized controlled trials. Esmolol and other beta-blocking adrenergic agents can have a significant effect on seizure duration during ECT, it shortens seizure duration, and this effect is probably dose dependent. Therefore routine administration is not recommended. Since the relation between seizure duration and efficacy of ECT is dependent on electrode placement it seems advisable to use bilateral electrode placement with patients with cardiovascular risk factors and an indication for use of esmolol during every session before seizure induction. In the absence of cardiovascular risk factors but with prolonging hypertension or tachycardia during ECT sessions, esmolol also is again preferred. Labetalol is an alternative although, especially in high dose, the longer half-life can be considered as a disadvantage. Experiences with landiolol are limited.

Keywords: Electroconvulsive therapy, beta-adrenergic blocking agents, anesthesia, esmolol, labetalol, landiolol, nicardipine, urapidil, depressive disorder