Caffeine-modified electroconvulsive therapy in depressed patients with medical illness.

Although pretreatment with intravenous caffeine is an effective technique for increasing seizure duration during a course of electroconvulsive therapy (ECT), little has been published regarding the use of this technique in patients with severe medical illness. The authors describe nine depressed inpatients with major cardiovascular or other medical disease or both whose ECT seizure durations declined despite maximal settings on the ECT device. In all cases, caffeine pretreatment lengthened seizures, and clinical improvement followed. The caffeine-modified ECT treatments were well tolerated and were associated with no clinically significant adverse cardiovascular effects.