Use of caffeine to lengthen seizures in ECT

During a course of ECT, seizure duration may become too brief for clinical benefit. Use of higher-energy stimuli may lengthen seizures but may also increase the risk of toxicity, and it is not possible when maximum settings are reached. The authors present the cases of six drug-free depressed inpatients whose seizure durations in ECT declined despite maximum settings on three different ECT devices. In all cases, pretreatment with caffeine lengthened seizures (mean increase = 107%), and clinical improvement followed. Caffeine was well tolerated, even in patients with cardiovascular diseases.