Question: Psychiatry service asked your help in management of a patient, who is transferred to ICU for Electroconvulsive Therapy (ECT). Which of the following drug may require reversal before initiating (ECT)? 

 A) lithium 
B) any antidepressant
C) any antipsychotic
D) any antihypertensive
E)  benzodiazepine


Answer: E

Most of the patient's prior drugs are safe during administration of ECT therapy, though lithium dose has been advocated to be decreased or on lower edge of therapeutic level 1.  

Benzodiazepines are usually discontinued before ECT therapy, but in those patients who still require them on board, should be transiently reversed just 2-3 minutes prior of ECT therapy with flumazenil. Benzodiazepines may decrease the intensity of the therapeutic ECT seizure.


References:

1.  Dolenc TJ, Rasmussen KG. The safety of electroconvulsive therapy and lithium in combination: a case series and review of the literature. J ECT 2005; 21:165. 

2. Greenberg RM, Pettinati HM. Benzodiazepines and Electroconvulsive Therapy. Convuls Ther 1993; 9:262. 

3. Krystal AD, Watts BV, Weiner RD, et al. The use of flumazenil in the anxious and benzodiazepine-dependent ECT patient. J ECT 1998; 14:5.