Do Antiepileptic Drugs Used During Electroconvulsive Therapy Impact Treatment Process?

PURPOSE: Whether the antiepileptic agents used by patients before the treatment should be discontinued after the initiation of the electroconvulsive therapy (ECT), which is one of the most effective treatment options in psychiatry, is a dilemma frequently faced by clinicians. Recently, there has been an increased interest in this subject. This study aimed to determine the impact of antiepileptic agents on ECT process in the event of continued use in the course of the therapy.

METHODS: From among the patients on an ECT therapy in the Psychiatry Clinic of Hacettepe University Hospital since 2010, a total of 39 patients who continued to use the antiepileptic agent they were taking prior to the ECT therapy were determined and included in the study. As for the control group, on the list of ECT patients, the 39 patients coming immediately after the patients using antiepileptics were taken up in the study. The patients using antiepileptics were compared with the control subjects on the basis of their sociodemographic characteristics, number of active sessions, energy levels of the past seizures, seizure durations, some clinical outcomes, and characteristics of the first and the last seizures.

RESULTS: There were no differences between the control subjects and those using the antiepileptics in terms of average age, body mass index, Clinical Global Impression scores, and sex distribution. Energy levels required to induce the first and the last seizures and total amounts of energy used in active seizures were significantly higher in patients taking the antiepileptics than the control group. Besides, the durations of the first peripheral and central seizures were significantly less in patients using the antiepileptics as compared with the control subjects. When sociodemographic variables and numeric data about the seizures were brought into the equation in the binary logistic regression analysis for determination of being included in either the group of patients taking antiepileptics or the control group, the only meaningful variable was found to be "duration of the first central seizure."

CONCLUSIONS: Continued use of the antiepileptics during ECT by the patients to undergo ECT may lead to an increased dose of energy to be used during the therapy. When all variables are taken into consideration, it was determined that the use of antiepileptic significantly shortened purely the duration of the first seizure. In the light of the present results, it does not seem meaningful to suggest as a conclusive requirement to discontinue the antiepileptics used before ECT prior to the commencement thereof.