2010 Volume 22 Issue 2 Pages 153-161
To optimize the effectiveness of electroconvulsive therapy (ECT) for the treatment of mood disorder or psychosis, it is essential to induce adequate seizures at stimulus intensity above "therapeutic threshold," which means 50% to 150% above seizure threshold in bilateral electrode placement. When only inadequate seizures including missed or abortive ones are induced at a maximum intensity, augmentation of seizure induction is necessary. The authors report three patients with depression and bipolar disorder who received a course of acute ECT with bifrontal electrode placement. After only inadequate seizures were produced at their sessions, switching anesthetic (to thiamylal from propofol), using flumazenil as preanesthetic medication and administering oral sustained-released theophylline (200mg) the night before ECT, respectively, successfully augmented seizures as adequate. No adverse effects were observed in all cases. There have been only a few reports on augmentation of seizure induction in Japan, while a number of studies have been conducted mainly in America. No reports on theophylline augmentation from Japan can be found. According to APA's ECT Task Force Report, these augmentation methods remain controversial in their effectiveness. However, our cases suggest that the augmentation may be effective and safe. Moreover, not a few psychiatrists in Japan still tend to believe "The longer the seizure duration, the more effective the ECT." We emphasize that the aim of augmentation is not to induce motor seizures or prolong seizure duration, but to induce adequate seizures, which should be judged mainly by electroencephalogram during ECT.
