Beta-blockers for electroconvulsive therapy: A systematic review and meta-analysis

Electroconvulsive therapy (ECT) is an established treatment for various mental disorders. However, ECT can induce significant haemodynamic fluctuations, raising safety concerns. This systematic review and meta-analysis aimed to evaluate the effects of adding beta-blockers to ECT on maximum heart rate after stimulation and the occurrence of adverse events. Only randomised controlled trials (RCTs) that compared the addition of beta-blockers to ECT with treatment as usual (TAU), such as placebo added to ECT or ECT without antihypertensive or antiarrhythmic medications, were included. The primary outcomes were maximum heart rate and the percentage of patients who experienced adverse events after stimulation. A total of 31 publications (33 studies, 42 comparisons, 1476 participants) were included. The beta-blocker group showed a significant reduction in maximum heart rate after stimulation compared to TAU group (28 publications, 29 studies, 38 comparisons, n = 1,375, mean difference (MD) = 21.98, 95% CI 17.94-26.02, p < 0.01). Significant differences were maintained in subgroup and sensitivity analyses. Furthermore, there was no significant increase in the risk of adverse events after stimulation compared to TAU group (20 publications, 21 studies, 27 comparisons, n = 1,014, RR = 1.44, 95% CI 0.93-2.25, p = 0.11). This is the first meta-analysis to assess the cardiovascular effects of beta-blockers during ECT. It demonstrated that the addition of beta-blockers to ECT may stabilise heart rate after stimulation without increasing adverse events. These results suggest that the addition of beta blockers may benefit high-risk patients who experience difficulty continuing ECT due to adverse events such as arrhythmias or tachycardia after stimulation.