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      Effects of Psychotropic Drugs on Seizure Threshold during Electroconvulsive Therapy

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          Abstract

          Objective

          To analyze the relationship between seizure threshold (ST) and psychotropic drugs in patients treated with ECT.

          Methods

          We examined clinical data from 43 patients. ST was titrated at each treatment session. We examined associations between ST and psychotropic drugs using multivariate correlation analyses. Data are presented as initial ST, the difference in ST between the first and 10th sessions (ΔST 10th), and the mean difference in ST between the first and last sessions (mean ΔST last).

          Results

          Multivariate regression analyses showed associations between initial ST and the total chlorpromazine-equivalent dose of antipsychotics (β=0.363, p<0.05). The total fluoxetine-equivalent dose of antidepressants was associated with ΔST 10th (β=0.486, p<0.01) and mean ΔST last (β=0.472, p<0.01).

          Conclusion

          Our study elucidated possible effects of psychotropic drugs on ST shifts. Larger doses of antipsychotics were associated with higher initial ST, whereas higher doses of antidepressants were associated with stronger shifts in ST.

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          Most cited references69

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          Dose equivalents of antidepressants: Evidence-based recommendations from randomized controlled trials.

          Yu Hayasaka, Marianna Purgato, Laura Magni … (2015)
          Dose equivalence of antidepressants is critically important for clinical practice and for research. There are several methods to define and calculate dose equivalence but for antidepressants, only daily defined dose and consensus methods have been applied to date. The purpose of the present study is to examine dose equivalence of antidepressants by a less arbitrary and more systematic method.
          Article 0 comments Cited 126 times – based on 0 reviews     Review now
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            Serotonin as a modulator of glutamate- and GABA-mediated neurotransmission: implications in physiological functions and in pathology.

            L Ciranna (2006)
            The neurotransmitter serotonin (5-HT), widely distributed in the central nervous system (CNS), is involved in a large variety of physiological functions. In several brain regions 5-HT is diffusely released by volume transmission and behaves as a neuromodulator rather than as a "classical" neurotransmitter. In some cases 5-HT is co-localized in the same nerve terminal with other neurotransmitters and reciprocal interactions take place. This review will focus on the modulatory action of 5-HT on the effects of glutamate and gamma-amino-butyric acid (GABA), which are the principal neurotransmitters mediating respectively excitatory and inhibitory signals in the CNS. Examples of interaction at pre-and/or post-synaptic levels will be illustrated, as well as the receptors involved and their mechanisms of action. Finally, the physiological meaning of neuromodulatory effects of 5-HT will be briefly discussed with respect to pathologies deriving from malfunctioning of serotonin system.
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              Effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy.

              Helen Fitzsimons, J Kiersky, H Sackeim … (1993)
              The efficacy of electroconvulsive therapy in major depression is established, but the importance of the electrical dosage and electrode placement in relation to efficacy and side effects is uncertain. In a double-blind study, we randomly assigned 96 depressed patients to receive right unilateral or bilateral electroconvulsive therapy at either a low electrical dose (just above the seizure threshold) or a high dose (2.5 times the threshold). Symptoms of depression and cognitive functioning were assessed before, during, immediately after, and two months after therapy. Patients who responded to treatment were followed for one year to assess the rate of relapse. The response rate for low-dose unilateral electroconvulsive therapy was 17 percent, as compared with 43 percent for high-dose unilateral therapy (P = 0.054), 65 percent for low-dose bilateral therapy (P = 0.001), and 63 percent for high-dose bilateral therapy (P = 0.001). Regardless of electrode placement, high dosage resulted in more rapid improvement (P < 0.05). Compared with the low-dose unilateral group, the high-dose unilateral group took 83 percent longer (P < 0.001) to recover orientation after seizure induction, whereas the combined bilateral groups took 252 percent longer (P < 0.001). During the week after treatment, there was three times more retrograde amnesia about personal information with bilateral therapy (P < 0.001). There were no differences between treatment groups in cognitive effects two months after treatment. Forty-one of the 70 patients who responded to therapy (59 percent) relapsed, and there were no differences between treatment groups. Increasing the electrical dosage increases the efficacy of right unilateral electroconvulsive therapy, although not to the level of bilateral therapy. High electrical dosage is associated with a more rapid response, and unilateral treatment is associated with less severe cognitive side effects after treatment.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Psychiatry Investig
                Journal ID (iso-abbrev): Psychiatry Investig
                Journal ID (publisher-id): PI
                Title: Psychiatry Investigation
                Publisher: Korean Neuropsychiatric Association
                ISSN (Print): 1738-3684
                ISSN (Electronic): 1976-3026
                Publication date (Print): September 2017
                Publication date (Electronic): 11 September 2017
                Volume: 14
                Issue: 5
                Pages: 647-655
                Affiliations
                [1 ]Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
                [2 ]Korea University Research Institute of Mental Health, Seoul, Republic of Korea.
                [3 ]Department of Biomedical Science, Korea University Graduate School, Seoul, Republic of Korea.
                [4 ]Seoul Metropolitan Enpyeong Hospital, Seoul, Republic of Korea.
                Author notes
                Correspondence: Hyun-Ghang Jeong, MD, PhD. Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul 08308, Republic of Korea. Tel: +82-2-2626-3164, Fax: +82-2-852-1937, parapraxis@ 123456naver.com
                Article
                DOI: 10.4306/pi.2017.14.5.647
                PMC ID: 5639133
                SO-VID: e370e614-146c-4015-8ebc-599a6b17dd8b
                Copyright © Copyright © 2017 Korean Neuropsychiatric Association
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 26 August 2016
                Date revision received : 27 September 2016
                Date accepted : 16 October 2016
                Funding
                Funded by: Korea University, CrossRef http://dx.doi.org/10.13039/501100002642;
                Award ID: K1512631
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: electroconvulsive therapy,seizure threshold,antipsychotics,antidepressants
                Data availability:
                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: electroconvulsive therapy, seizure threshold, antipsychotics, antidepressants

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