The Journal of ECT

Skip Navigation LinksHome > September 2010 - Volume 26 - Issue 3 > Augmentation Strategies in Electroconvulsive Therapy
Journal of ECT:
doi: 10.1097/YCT.0b013e3181e48143
Invited Review

Augmentation Strategies in Electroconvulsive Therapy

Loo, Colleen FRANZCP, MD*†‡; Simpson, Brett FRANZCP*§; MacPherson, Ross PhD, FANZCA∥

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Electroconvulsive therapy (ECT) is a highly effective treatment, but strategies to enhance therapeutic outcomes are occasionally needed. This review examines the evidence for approaches used for enhancing seizure production: hyperventilation, pretreatment with xanthines, and use of remifentanil or ketamine in ECT anesthesia. Hyperventilation may be a useful strategy to enhance seizure production, but its effects on ECT outcomes have not been systematically studied and require further research. Pretreatment with caffeine, theophylline or aminophylline (xanthines) prolongs the duration of ECT seizures but has not been clearly shown in controlled trials to increase efficacy. Caution is also warranted because their use may be associated with significant adverse effects. There are case reports of the usefulness of remifentanil in assisting seizure induction by reducing the dose of barbiturate anesthetic required, but there are no controlled data on whether it independently enhances efficacy outcomes. Preliminary evidence suggests that ketamine and ECT may have synergistic antidepressant effects, although this needs to be further examined in randomized controlled trials.

© 2010 Lippincott Williams & Wilkins, Inc.


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