Increased seizure threshold related to tamoxifen

Both animal and human evidence suggest that estrogen has a modulatory role in seizure threshold, although there have been no reports to date suggesting the relevance of this to ECT practice. We describe the case of a woman who had been receiving maintenance ECT for several years with a stable seizure threshold. She developed breast cancer and ultimately agreed to begin estrogen deprivation therapy with tamoxifen; this treatment regimen resulted in an increased seizure threshold, necessitating an increase in stimulus power settings. ECT practitioners should be aware that estrogen deprivation therapy may have the potential to alter seizure threshold.