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Venlafaxin-associated post-ictal asystole during electroconvulsive therapy
Pharmacopsychiatry
|November 17, 2011
Summary
Post-ictal asystole during electroconvulsive therapy (ECT) is rare. This case suggests venlafaxine may increase risks, particularly in elderly patients, due to its noradrenergic effects.
Area of Science:
- Neuroscience
- Psychiatry
- Clinical Medicine
Background:
- Electroconvulsive therapy (ECT) is a treatment for severe depression.
- Post-ictal asystole is a rare but serious adverse event following ECT.
- Elderly patients with comorbidities may have increased risks.
Observation:
- An 82-year-old female with major depressive episode experienced a 6-second post-ictal asystole with ventricular escape beats during ECT.
- The patient had a history of bipolar disorder and mild Alzheimer's disease, with previous successful ECT treatments.
- Medications included venlafaxine, quetiapine, donepezil, and clonidine; anesthesia used ketamine and succinylcholine.
Findings:
- Concurrent medication was unchanged except for venlafaxine, potentially at high serum levels.
- The noradrenergic action of venlafaxine is suspected to have contributed to the post-ictal asystole.
- This event highlights a potential interaction between ECT and venlafaxine.
Implications:
- The combination of ECT and venlafaxine may pose a risk, especially in the elderly.
- Clinicians should carefully consider venlafaxine use in elderly patients undergoing ECT.
- Further research is warranted to elucidate the safety profile of venlafaxine with ECT.
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