In this recently published review we summarized the results of the placebo-controlled randomized clinical trials with beta-blocking adrenergic agents during electroconvulsive therapy (ECT), and review the effect on seizure duration and cardiovascular variables.
Esmolol can have a significant effect on seizure duration during ECT, it shortens seizure duration, and this effect is probably dose dependent.
Since the relation between seizure duration and efficacy of ECT is dependent on electrode placement it seems advisable to use bilateral electrode placement with patients with cardiovascular risk factors and use of esmolol during every session before seizure induction. One should take into account the possible negative effect of esmolol on seizure duration in these cases and adhere to the guidelines for ECT that advise at least 10 treatment sessions with bilateral ECT before one can conclude that ECT is not efficacious.
In the absence of cardiovascular risk factors but with prolonging hypertension or tachycardia during ECT sessions, esmolol also is again preferred. Labetalol is an alternative although, especially in high dose, the longer half-life can be considered as a disadvantage. Experiences with landiolol are limited but the short half-life, greater degree of cardioselectivity and more potency makes it a promising alternative.
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