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Tijdschrift voor Psychiatrie 50 (2008) 4, 205 - 215

New research

Beta-blockers and electroconvulsive therapy: a review

W.W. van den Broek, T.H.N. Groenland, P.G.H. Mulder, A. Kusuma, T.K. Birkenhäger, E.M. Pluijms, J.A. Bruijn

summary
background When patients with cardiovascular disorders undergo electroconvulsive therapy (ect) they sometimes have to be treated for tachycardia and high blood pressure.
aim To describe the effects of β-blockers on seizure duration and cardiovascular variables in patients undergoing ect.
method Search for studies in Medline, with the keywords 'beta-adrenergic blocking agents' and 'electroconvulsive therapy'. Only articles based on randomised placebo-controlled investigations were included.
results The search strategy produced 21 articles. These were assessed by all authors. Esmolol was the drug administered in most of the trials. Since seizure duration can influence the therapeutic effect of ect it is advisable to use bilateral electrode placement in patients with cardiovascular risk factors and to administer esmolol prior to seizure induction.
conclusion The beta-blocker of choice for use during ect seems to be esmolol; it can shorten seizure duration, although the effect is probably dose-dependent. Esmolol is also the drug of choice in ect sessions for patients without cardiovascular risk factors but who develop prolonged hypertension or tachycardia. A possible alternative is labetalol, but its longer half-life is a disadvantage, particularly if it is administered in a high dose. So far, experience with landiolol is limited, but its short half-life, greater cardioselectivity and higher potency mean that it could be a promising alternative.

keywords adrenergic beta-antagonists, electroconvulsive therapy, ECT, esmolol, labetalol, landiolol