Tang Victor M, Pasricha Akash N, Blumberger Daniel M, Voineskos Daphne, Pasricha Suvercha, Mulsant Benoit H, Daskalakis Zafiris J
J ECT. 2017 Dec;33(4):237-242. doi: 10.1097/YCT.0000000000000441.
This study aims to investigate the clinical effects of benzodiazepines or anticonvulsant use during a course of electroconvulsive therapy (ECT).
A case report study of a patient who received ECT with and without concomitant flurazepam and pregabalin is presented. The literature on the use of benzodiazepines and anticonvulsants during ECT is reviewed.
A woman with treatment resistant depression received a course of ECT while taking flurazepam and pregabalin, but seizures were of short duration and symptomatic improvement was minimal. After discontinuation of flurazepam and pregabalin, a course of right unilateral ultrabrief ECT was associated with adequate seizures and remission of depression and suicidal ideation. Our literature review suggests that benzodiazepines decrease seizure duration, but most evidence shows no association with increased seizure threshold. One prospective RCT and 3 large retrospective studies found that benzodiazepines compromise the efficacy of unilateral but not bilateral ECT. Regarding anticonvulsants, several studies had varied and contradictory results on their effect on seizure duration and seizure threshold. Of the 2 large retrospective studies and 3 RCTs, only 1 retrospective study showed that anticonvulsants decrease the efficacy of ECT.
Judicious assessment of all medications used in combination with ECT is recommended. Overall, published studies suggest that benzodiazepines and anticonvulsants impact the clinical outcomes of ECT less than what would be expected given their pharmacologic effects. However, there are significant gaps in the literature, including a lack of study on suprathreshold stimulation of right unilateral ECT and the possibility of a greater effect with higher medication doses.
本研究旨在探讨在电休克治疗（ECT）过程中使用苯二氮䓬类药物或抗惊厥药物的临床效果。
本文报告了一例接受ECT治疗的患者，分别在使用和未使用氟西泮及普瑞巴林的情况下进行治疗，并对ECT期间使用苯二氮䓬类药物和抗惊厥药物的文献进行了综述。
一名患有难治性抑郁症的女性在服用氟西泮和普瑞巴林的同时接受了一个疗程的ECT治疗，但发作持续时间较短，症状改善甚微。停用氟西泮和普瑞巴林后，一个疗程的右侧单侧超短程ECT治疗与充分的发作以及抑郁症和自杀观念的缓解相关。我们的文献综述表明，苯二氮䓬类药物会缩短发作持续时间，但大多数证据表明其与发作阈值升高无关。一项前瞻性随机对照试验（RCT）和三项大型回顾性研究发现，苯二氮䓬类药物会损害单侧ECT的疗效，但对双侧ECT无影响。关于抗惊厥药物，几项研究在其对发作持续时间和发作阈值的影响方面结果各异且相互矛盾。在两项大型回顾性研究和三项RCT中，只有一项回顾性研究表明抗惊厥药物会降低ECT的疗效。
建议对与ECT联合使用的所有药物进行审慎评估。总体而言，已发表的研究表明，鉴于苯二氮䓬类药物和抗惊厥药物的药理作用，它们对ECT临床结果的影响小于预期。然而，文献中仍存在重大空白，包括缺乏对右侧单侧ECT阈上刺激的研究以及更高药物剂量可能产生更大影响的可能性。
