Article information
Abstract
Introduction
The simultaneous application of electroconvulsive therapy (ECT) and psychotropic drugs is based on sparse data. Despite this, and the restrictive approach of the Guidelines and Consensus is widespread in the usual care, it is widely practiced in routine clinical.
MethodWe reviewed the results of search on the topic in MEDLINE, PsychINFO, EMBASE and Cochrane, and the main guidelines on the subject and analyzed for drug groups.
ResultsExcept some reservation with regard to classical MAOIs, antidepressants are safe and effective enhancers of the TEC. It is desirable to discontinuation of BZD whenever clinically possible before the course of ECT for risk of interference, if not possible will have to use proper technique to ensure effective incentives. It is advisable to stop or reduce the dose of lithium prior to ECT based on a cost-benefit analysis of the risk of relapse, if maintained will be adjusted lower levels and cognitive effects minimizing techniques . The combination with «classic» and «atypical» antipsychotics power positive clinical effects and the risk of combined use is low. The positive data are collected with clozapine and ECT-resistant psychosis, with little presence of effects of the decrease of seizure threshold by clozapine, and important effect of empowerment, but of limited duration.
ConclusionsAlthough it is strictly necessary to identify situations in terms of drugs, patient and ECT technique, and care necessary to develop tests that provide methodologically sound data, the combined use of ECT and psychotropic drugs in general presents an acceptable risk level and efficacy data by encouraging empowerment
Keywords:
Electroconvulsive therapy
Psychotropic drugs
Resumen
Introducción
La aplicación simultánea de tratamiento electroconvulsivo (TEC) y psicofármacos se sustenta en datos escasos. A pesar de ello, y de la actitud restrictiva de las guías y consensos, es de un uso generalizado en la práctica clínica.
MétodoSe revisan los resultados de búsqueda sobre el tema en MEDLINE, PsychINFO, EMBASE y Cochrane, así como las principales guías sobre el tema y se analizan por grupos farmacológicos
ResultadosSalvo cierta reserva respecto a los inhibidores de la monoamino oxidasa clásicos, los antidepresivos resultan seguros y eficaces potenciadores del TEC. Resulta deseable la retirada de las benzodiacepinas siempre que sea clínicamente viable antes del curso de TEC, por riesgo de interferencia en la estimulación; si no es posible, habrá que emplear la técnica apropiada que asegure estímulos eficaces. Es recomendable interrumpir o reducir la dosis de litio previo al TEC a partir de un análisis coste-beneficio del riesgo de recaída; en caso de mantenerse, se ajustarán valores menores y técnica minimizadora de efectos cognitivos. La combinación con antipsicóticos “clásicos” y “atípicos” potencia los efectos clínicos positivos y el riesgo de uso combinado es bajo. Los datos más positivos se recogen con clozapina y TEC en psicosis resistente, con escasa presencia de efectos derivados del descenso del umbral de convulsión por clozapina, e importante efecto de potenciación, aunque de duración limitada.
ConclusionesAunque es preciso individualizar rigurosamente las situaciones en función de fármacos, paciente y técnica de TEC, y necesario desarrollar ensayos metodológicamente cuidados que ofrezcan datos firmes, el uso conjunto de TEC y psicofármacos presenta en general un nivel de riesgo asumible y datos de eficacia por potenciación esperanzadores.
Palabras clave:
Tratamiento electroconvulsivo
Psicofármacos
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