Medications to Discontinue Prior to Electroconvulsive Therapy (ECT)

High Priority Medications to Discontinue

The American Academy of Child and Adolescent Psychiatry recommends discontinuing lithium during ECT when clinically possible due to reports of acute brain syndrome when used concurrently with ECT 3, 4
Trazodone should be discontinued due to reported adverse side effects, specifically prolonged seizures during ECT, as recommended by the American Academy of Child and Adolescent Psychiatry 3, 5
Carbamazepine should be discontinued as it has been associated with failure to induce seizures during ECT, according to the American Academy of Child and Adolescent Psychiatry 3, 2
Theophylline should be discontinued as it is known to prolong seizure duration at both therapeutic and toxic levels, as stated by the American Academy of Child and Adolescent Psychiatry 1, 5
Benzodiazepines should be discontinued as they may increase seizure threshold, potentially making it difficult to induce therapeutic seizures, as recommended by the American Academy of Child and Adolescent Psychiatry 1

The American Academy of Child and Adolescent Psychiatry suggests assessing medication regimen and reviewing all current medications for potential interactions with ECT 2
The American Academy of Child and Adolescent Psychiatry recommends prioritizing discontinuation of medications, with lithium, trazodone, carbamazepine, and theophylline being the highest risk 3, 5
For adolescents, extra caution is warranted as they may have lower seizure thresholds and more prolonged seizures with ECT than adults, according to the American Academy of Child and Adolescent Psychiatry 2, 6

If medications cannot be discontinued due to clinical necessity, they may be administered with appropriate monitoring, as stated by the American Academy of Child and Adolescent Psychiatry 1, 2
Prolonged seizures can occur in 0-10% of ECT treatments and may require termination with additional methohexital, diazepam, or lorazepam, according to the American Academy of Child and Adolescent Psychiatry 6
Tardive seizures are a rare but serious side effect that requires neurological consultation, as recommended by the American Academy of Child and Adolescent Psychiatry 6, 7

After completing the ECT course, medications can typically be restarted based on clinical need, as stated by the American Academy of Child and Adolescent Psychiatry 2
Careful monitoring should be provided for at least 24 hours after ECT for potential tardive seizures, according to the American Academy of Child and Adolescent Psychiatry 7
If seizure-related complications occur, appropriate medical consultation should be obtained before resuming ECT, as recommended by the American Academy of Child and Adolescent Psychiatry 6