Prior to ECT, Dr. Cohen said he considers discontinuing or minimizing medications that have anticonvulsant effects, such as carbamazepine and lamotrigine and benzodiazepines. “On the other hand, you don’t want the patient relapsing right as you’re starting your treatment, so it might be that you can’t get them off benzodiazepines completely,” he said.
According to a recent meta-analysis of 32 studies, the most robust predictors of poor response to ECT were longer depressive episode duration and medication resistance, while age, psychosis, and melancholic features were not found to be as clinically useful (J Clin Psychiatry. 2015;76[10]:1374-84). Dr. Cohen noted that a major consideration during a pre-ECT consultation is working out any potential logistical difficulties in advance. For example, during an acute course of ECT, he said he advises patients not to drive, even on nontreatment days.
“If you live in a city with good public transportation, it may not be a big deal, but it can be difficult in more rural areas,” he said. “It’s not that ECT makes you lose the memory of how to drive a car, but could give you subtle cognitive slowing or decreased reaction times. Therefore, arranging to have an adequate support system throughout the course of ECT is essential.”
Dr. Cohen reported having no relevant financial conflicts.