How Much Do Benzodiazepines Matter for Electroconvulsive Therapy in Patients With Major Depression?

BACKGROUND Electroconvulsive therapy (ECT) is one of the most effective treatments for major depressive disorder (MDD), especially in cases of treatment-resistant MDD. Because of their pharmacological profiles, benzodiazepines (BZDs) are suspected to decrease the efficacy of ECT. This study investigated the effect of BZDs on ECT-induced clinical outcomes and ECT course parameters in patients with MDD. METHOD The impact of BZDs on severity of depression (Montgomery-Asberg Depression Rating Scale scores) and on ECT course parameters (seizure threshold, clinical and electroencephalographic seizure duration) was investigated in 70 patients with MDD who received an ECT course using dose-titration method (22 received concomitant BZDs). RESULTS Lower remission rates (52.0%) and smaller decreases in Montgomery-Asberg Depression Rating Scale scores were observed in the non-BZD group than in the BZD group (81.2%, P = 0.02). There were no significant differences between the 2 groups regarding seizure duration and seizure threshold. LIMITATIONS This was a retrospective study. Impact of BZDs on anxiety and cognition was not assessed. CONCLUSIONS Benzodiazepines increased the clinical efficacy of ECT when delivered using dose-titration method and bitemporal stimulation. Further studied are needed to understand the interaction between BZDs and ECT on clinical outcomes.

[1]  B. Mulsant,et al.  Should Benzodiazepines and Anticonvulsants Be Used During Electroconvulsive Therapy?: A Case Study and Literature Review , 2017, The journal of ECT.

[2]  Chang Yoon Kim,et al.  Effects of stimulus parameters on motor seizure duration in electroconvulsive therapy , 2017, Neuropsychiatric disease and treatment.

[3]  J. Thirthalli,et al.  Effect of age and anticonvulsants on seizure threshold during bilateral electroconvulsive therapy with brief-pulse stimulus: A chart-based analysis , 2016, Indian journal of psychiatry.

[4]  C. Loo,et al.  Predictors of Seizure Threshold in Right Unilateral Ultrabrief Electroconvulsive Therapy: Role of Concomitant Medications and Anaesthesia Used , 2015, Brain Stimulation.

[5]  A. Nunomura,et al.  Seizure threshold and the half‐age method in bilateral electroconvulsive therapy in Japanese patients , 2015, Psychiatry and clinical neurosciences.

[6]  S. Kasper,et al.  Neurotransmitters and Electroconvulsive Therapy , 2014, The journal of ECT.

[7]  G. Freedman,et al.  Burden of Depressive Disorders by Country, Sex, Age, and Year: Findings from the Global Burden of Disease Study 2010 , 2013, PLoS medicine.

[8]  C. Loo,et al.  Do benzodiazepines moderate the effectiveness of bitemporal electroconvulsive therapy in major depression? , 2013, Journal of affective disorders.

[9]  E. Giltay,et al.  Clinical predictors of seizure threshold in electroconvulsive therapy: a prospective study , 2012, European Archives of Psychiatry and Clinical Neuroscience.

[10]  T. Birkenhäger,et al.  Efficacy of electroconvulsive therapy in bipolar versus unipolar major depression: a meta‐analysis , 2012, Bipolar disorders.

[11]  T. Bolwig.  How Does Electroconvulsive Therapy Work? Theories on its Mechanism , 2011, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[12]  Elaine M. Dillingham,et al.  Effect of concomitant pharmacotherapy on electroconvulsive therapy outcomes: short-term efficacy and adverse effects. , 2009, Archives of general psychiatry.

[13]  A. Cleare,et al.  The Maudsley Staging Method for treatment-resistant depression: prediction of longer-term outcome and persistence of symptoms. , 2009, The Journal of clinical psychiatry.

[14]  S. Crowe,et al.  Cognitive Effects of Long-Term Benzodiazepine Use , 2004, CNS Drugs.

[15]  John R. Geddes,et al.  Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis , 2003, The Lancet.

[16]  T. Gale,et al.  Defining remission by cut off score on the MADRS: selecting the optimal value. , 2002, Journal of affective disorders.

[17]  M. Könönen,et al.  SPECT and neuropsychological performance in severe depression treated with ECT. , 2001, Journal of affective disorders.

[18]  H. Sackeim,et al.  Determinants of seizure threshold in ECT: benzodiazepine use, anesthetic dosage, and other factors. , 2000, The journal of ECT.

[19]  H. Sackeim.  The anticonvulsant hypothesis of the mechanisms of action of ECT: current status. , 1999, The journal of ECT.

[20]  G. Stein,et al.  Decreased efficacy of combined benzodiazepines and unilateral ECT in treatment of depression , 1996, Acta psychiatrica Scandinavica.

[21]  I. Ferrier,et al.  The effect of psychotropic medication on seizure duration during bilateral electroconvulsive therapy: a retrospective study , 1996, Journal of psychopharmacology.

[22]  H. Sackeim,et al.  Stimulus intensity, seizure threshold, and seizure duration: impact on the efficacy and safety of electroconvulsive therapy. , 1991, The Psychiatric clinics of North America.

[23]  H. Pettinati,et al.  Evidence for less improvement in depression in patients taking benzodiazepines during unilateral ECT. , 1990, The American journal of psychiatry.

[24]  S. Ericksen,et al.  Efficacy of ECT: a meta-analysis. , 1985, The American journal of psychiatry.

[25]  R. Snaith,et al.  The relationship of concurrent benzodiazepine administration to seizure duration in ECT , 1985, Acta psychiatrica Scandinavica.

[26]  M. Åsberg,et al.  A New Depression Scale Designed to be Sensitive to Change , 1979, British Journal of Psychiatry.

[27]  L. Koran,et al.  Electroconvulsive therapy. , 1996, Psychiatric services.

[28]  P. Nettelbladt.  Factors Influencing Number of Treatments and Seizure Duration in ECT: Drug Treatment, Social Class. , 1988, Convulsive therapy.

[29]  D. Greenblatt,et al.  Drug therapy. Current status of benzodiazepines. , 1983, The New England journal of medicine.