Medication preventing postictal hypoperfusion and cognitive side-effects in electroconvulsive therapy: A retrospective cohort study
BackgroundElectroconvulsive therapy (ECT) is associated with postictal confusion and cognitive side-effects. In rats, acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs) and calcium antagonists decreased postictal cerebral hypoperfusion along with reduction in postictal symptoms. In this s...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2023-02-01
|
| Series: | Frontiers in Psychiatry |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1026014/full |
| _version_ | 1828038337296859136 |
|---|---|
| author | Joey P. A. J. Verdijk Joey P. A. J. Verdijk Gijsbert Schuur Julia C. M. Pottkämper Julia C. M. Pottkämper Freek ten Doesschate Jeannette Hofmeijer Jeannette Hofmeijer Jeroen A. van Waarde |
| author_facet | Joey P. A. J. Verdijk Joey P. A. J. Verdijk Gijsbert Schuur Julia C. M. Pottkämper Julia C. M. Pottkämper Freek ten Doesschate Jeannette Hofmeijer Jeannette Hofmeijer Jeroen A. van Waarde |
| author_sort | Joey P. A. J. Verdijk |
| collection | DOAJ |
| description | BackgroundElectroconvulsive therapy (ECT) is associated with postictal confusion and cognitive side-effects. In rats, acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs) and calcium antagonists decreased postictal cerebral hypoperfusion along with reduction in postictal symptoms. In this study, in ECT-patients, we explore associations between use of these potentially protective medications and occurrence of postictal confusion and cognitive outcome.Materials and methodsIn this retrospective, naturalistic cohort study, patient-, treatment-, and ECT-characteristics, were collected from medical files of patients treated with ECT for major depressive disorder (MDD) or bipolar depressive episode. To test for associations of use of these medications with occurrence of postictal confusion, 295 patients could be included. Cognitive outcome data were available in a subset of 109 patients. Univariate analyses and multivariate censored regression models were used to test for associations.ResultsOccurrence of severe postictal confusion was not associated with use of acetaminophen, NSAIDs or calcium antagonists (n = 295). Regarding the cognitive outcome measure (n = 109), use of calcium antagonists was associated with higher post-ECT cognitive scores (i.e., better cognitive outcome; β = 2.23; p = 0.047), adjusted for age (β = −0.02; p = 0.23), sex (β = −0.21; p = 0.73), pre-ECT cognitive score (β = 0.47; p < 0.0001), and post-ECT depression score (β = −0.02; p = 0.62), but use of acetaminophen (β = −1.55; p = 0.07) as well as NSAIDs (β = −1.02; p = 0.23) showed no associations.ConclusionThis retrospective study does not find arguments for protective effects of acetaminophen, NSAIDs or calcium antagonists against severe postictal confusion in ECT. As a preliminary finding, the use of calcium antagonists was associated with improved cognitive outcome after ECT in this cohort. Prospective controlled studies are necessary. |
| first_indexed | 2024-04-10T16:25:31Z |
| format | Article |
| id | doaj.art-2597aeffd91c42548a9df24b986d7b2a |
| institution | Directory Open Access Journal |
| issn | 1664-0640 |
| language | English |
| last_indexed | 2024-04-10T16:25:31Z |
| publishDate | 2023-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Psychiatry |
| spelling | doaj.art-2597aeffd91c42548a9df24b986d7b2a2023-02-09T06:32:39ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402023-02-011410.3389/fpsyt.2023.10260141026014Medication preventing postictal hypoperfusion and cognitive side-effects in electroconvulsive therapy: A retrospective cohort studyJoey P. A. J. Verdijk0Joey P. A. J. Verdijk1Gijsbert Schuur2Julia C. M. Pottkämper3Julia C. M. Pottkämper4Freek ten Doesschate5Jeannette Hofmeijer6Jeannette Hofmeijer7Jeroen A. van Waarde8Department of Psychiatry, Rijnstate Hospital, Arnhem, NetherlandsDepartment of Clinical Neurophysiology, TechMed Centre, University of Twente, Enschede, NetherlandsDepartment of Psychiatry, Rijnstate Hospital, Arnhem, NetherlandsDepartment of Psychiatry, Rijnstate Hospital, Arnhem, NetherlandsDepartment of Clinical Neurophysiology, TechMed Centre, University of Twente, Enschede, NetherlandsDepartment of Psychiatry, Rijnstate Hospital, Arnhem, NetherlandsDepartment of Clinical Neurophysiology, TechMed Centre, University of Twente, Enschede, NetherlandsDepartment of Neurology, Rijnstate Hospital, Arnhem, NetherlandsDepartment of Psychiatry, Rijnstate Hospital, Arnhem, NetherlandsBackgroundElectroconvulsive therapy (ECT) is associated with postictal confusion and cognitive side-effects. In rats, acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs) and calcium antagonists decreased postictal cerebral hypoperfusion along with reduction in postictal symptoms. In this study, in ECT-patients, we explore associations between use of these potentially protective medications and occurrence of postictal confusion and cognitive outcome.Materials and methodsIn this retrospective, naturalistic cohort study, patient-, treatment-, and ECT-characteristics, were collected from medical files of patients treated with ECT for major depressive disorder (MDD) or bipolar depressive episode. To test for associations of use of these medications with occurrence of postictal confusion, 295 patients could be included. Cognitive outcome data were available in a subset of 109 patients. Univariate analyses and multivariate censored regression models were used to test for associations.ResultsOccurrence of severe postictal confusion was not associated with use of acetaminophen, NSAIDs or calcium antagonists (n = 295). Regarding the cognitive outcome measure (n = 109), use of calcium antagonists was associated with higher post-ECT cognitive scores (i.e., better cognitive outcome; β = 2.23; p = 0.047), adjusted for age (β = −0.02; p = 0.23), sex (β = −0.21; p = 0.73), pre-ECT cognitive score (β = 0.47; p < 0.0001), and post-ECT depression score (β = −0.02; p = 0.62), but use of acetaminophen (β = −1.55; p = 0.07) as well as NSAIDs (β = −1.02; p = 0.23) showed no associations.ConclusionThis retrospective study does not find arguments for protective effects of acetaminophen, NSAIDs or calcium antagonists against severe postictal confusion in ECT. As a preliminary finding, the use of calcium antagonists was associated with improved cognitive outcome after ECT in this cohort. Prospective controlled studies are necessary.https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1026014/fullelectroconvulsive therapyacetaminophennon-steroidal anti-inflammatory drugscalcium antagonistscognitive outcome |
| spellingShingle | Joey P. A. J. Verdijk Joey P. A. J. Verdijk Gijsbert Schuur Julia C. M. Pottkämper Julia C. M. Pottkämper Freek ten Doesschate Jeannette Hofmeijer Jeannette Hofmeijer Jeroen A. van Waarde Medication preventing postictal hypoperfusion and cognitive side-effects in electroconvulsive therapy: A retrospective cohort study Frontiers in Psychiatry electroconvulsive therapy acetaminophen non-steroidal anti-inflammatory drugs calcium antagonists cognitive outcome |
| title | Medication preventing postictal hypoperfusion and cognitive side-effects in electroconvulsive therapy: A retrospective cohort study |
| title_full | Medication preventing postictal hypoperfusion and cognitive side-effects in electroconvulsive therapy: A retrospective cohort study |
| title_fullStr | Medication preventing postictal hypoperfusion and cognitive side-effects in electroconvulsive therapy: A retrospective cohort study |
| title_full_unstemmed | Medication preventing postictal hypoperfusion and cognitive side-effects in electroconvulsive therapy: A retrospective cohort study |
| title_short | Medication preventing postictal hypoperfusion and cognitive side-effects in electroconvulsive therapy: A retrospective cohort study |
| title_sort | medication preventing postictal hypoperfusion and cognitive side effects in electroconvulsive therapy a retrospective cohort study |
| topic | electroconvulsive therapy acetaminophen non-steroidal anti-inflammatory drugs calcium antagonists cognitive outcome |
| url | https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1026014/full |
| work_keys_str_mv | AT joeypajverdijk medicationpreventingpostictalhypoperfusionandcognitivesideeffectsinelectroconvulsivetherapyaretrospectivecohortstudy AT joeypajverdijk medicationpreventingpostictalhypoperfusionandcognitivesideeffectsinelectroconvulsivetherapyaretrospectivecohortstudy AT gijsbertschuur medicationpreventingpostictalhypoperfusionandcognitivesideeffectsinelectroconvulsivetherapyaretrospectivecohortstudy AT juliacmpottkamper medicationpreventingpostictalhypoperfusionandcognitivesideeffectsinelectroconvulsivetherapyaretrospectivecohortstudy AT juliacmpottkamper medicationpreventingpostictalhypoperfusionandcognitivesideeffectsinelectroconvulsivetherapyaretrospectivecohortstudy AT freektendoesschate medicationpreventingpostictalhypoperfusionandcognitivesideeffectsinelectroconvulsivetherapyaretrospectivecohortstudy AT jeannettehofmeijer medicationpreventingpostictalhypoperfusionandcognitivesideeffectsinelectroconvulsivetherapyaretrospectivecohortstudy AT jeannettehofmeijer medicationpreventingpostictalhypoperfusionandcognitivesideeffectsinelectroconvulsivetherapyaretrospectivecohortstudy AT jeroenavanwaarde medicationpreventingpostictalhypoperfusionandcognitivesideeffectsinelectroconvulsivetherapyaretrospectivecohortstudy |