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Pharmacopsychiatry 2012; 45(03): 122-124
DOI: 10.1055/s-0031-1291349
Letter
© Georg Thieme Verlag KG Stuttgart · New York

Venlafaxin-Associated Post-Ictal Asystole during Electroconvulsive Therapy

L. Kranaster
1   Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, 68159 Mannheim, Germany
,
C. Janke
3   Department of Anaesthesiology and Surgical Intensive Care Medicine, University Medical Centre, Mannheim, Germany
,
L. Hausner
2   Department of Geriatric Psychiatry, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
,
L. Frölich
2   Department of Geriatric Psychiatry, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
,
A. Sartorius
1   Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, 68159 Mannheim, Germany
› Author Affiliations
Further Information

Publication History

received 25 July 2011
revised 21 September 2011

accepted 10 October 2011

Publication Date:
15 November 2011 (online)

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Abstract

While post-stimulus asystoles occur quite often during electroconvulsive therapy (ECT) post-ictal or post-seizure sinus bradycardias or even asystoles are rare events. We report the case of an 82-year-old female patient with a current major depressive episode, who developed the rare event of a post-ictal asystole of 6 s and 4 ventricular escape beats during ECT. In the past this patient with a bipolar disorder and mild Alzheimer’s disease had already been frequently treated with ECT with good success and no adverse events. Relevant comedication was venlafaxin, quetiapine, donepezil and clonidine, anesthesia was performed with ketamine and succinylcholine. Concurrent medication was completely unchanged compared to previous ECT sessions with the exception of venlafaxine, presumably at high serum levels. In summary, in line with some already existing reports, we expect the noradrenergic action of venlafaxin to have contributed substantially to the post-ictal asystole and want to indicate that the combination of ECT and venlafaxin might be harmful −  especially in the elderly population.

Key words

bipolar disorder treatment - electroconvulsive therapy (ECT) - depression treatment - venlafaxin - geriatric psychiatry
 

  • References

  • 1 Nagler J. Placement of stimulus electrodes and heart rate during electroconvulsive therapy. Fortschr Neurol Psychiatr 2010; 78: 599-604
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Hausner L, Damian M, Sartorius A et al. Efficacy and cognitive side effects of electroconvulsive therapy (ECT) in depressed elderly inpatients with coexisting mild cognitive impairment or dementia. J Clin Psychiatry 2011; 72: 91-97
    CrossrefPubMedGoogle Scholar
  • 3 Sartorius A, Hewer W. Safe performance of ECT in severely ill patients: A retrospective study. Eur J Psychiat 2007; 21: 237-247
    PubMedGoogle Scholar
  • 4 Bhat SK, Acosta D, Swartz CM. Postictal asystole during ECT. J ECT 2002; 18: 103-106
    CrossrefPubMedGoogle Scholar
  • 5 Kranaster L, Kammerer-Ciernioch J, Hoyer C et al. Sartorius A. Clinically favourable effects of ketamine as an anaesthetic for electroconvulsive therapy: a retrospective study. Eur Arch Psychiatry Clin Neurosci 2011; Mar 13 [Epub ahead of print]
    PubMedGoogle Scholar
  • 6 Sackeim HA, Dillingham EM, Prudic J et al. Effect of concomitant pharmacotherapy on electroconvulsive therapy outcomes: short-term efficacy and adverse effects. Arch Gen Psychiatry 2009; 66: 729-737
    CrossrefPubMedGoogle Scholar
  • 7 Agelink MM, Zeit T, Klieser E. Prolonged bradycardia complicates antidepressive treatment with venlafaxine and ECT. Br J Psychiatry 1998; 173: 441-441
    PubMedGoogle Scholar
  • 8 Gonzalez-Pinto A, Gutierrez M, Gonzalez N et al. Efficacy and safety of venlafaxine-ECT combination in treatment-resistant depression. J Neuropsychiatry Clin Neurosci 2002; 14: 206-209
    CrossrefPubMedGoogle Scholar
  • 9 Bundy BD, Hewer W, Andres FJ et al. Influence of anesthetic drugs and concurrent psychiatric medication on seizure adequacy during electroconvulsive therapy. J Clin Psychiatry 2010; 71: 775-777
    CrossrefPubMedGoogle Scholar
  • 10 Sartorius A, Munoz-Canales EM, Krumm B et al. ECT anesthesia: the lighter the better?. Pharmacopsychiatry 2006; 39: 201-204
    Article in Thieme ConnectPubMedGoogle Scholar