Continuing Olanzapine and Mirtazapine During Electroconvulsive Therapy (ECT)
Both olanzapine and mirtazapine can be safely continued during electroconvulsive therapy (ECT) without significant adverse effects on treatment efficacy or safety. 1, 2
Safety and Efficacy of Continuing These Medications
Olanzapine During ECT
- Olanzapine can be safely continued during ECT and may even provide beneficial effects 2
- Recent research shows that concomitant olanzapine administration during ECT does not reduce the effectiveness of ECT treatment 2
- Olanzapine has been shown to have epileptogenic properties that may actually enhance seizure activity during ECT 3
- Orally disintegrating olanzapine has been used prophylactically to prevent postictal agitation in patients undergoing ECT 4
Mirtazapine During ECT
- Mirtazapine can be safely continued during ECT and may enhance therapeutic effectiveness 1
- Studies have shown that mirtazapine does not negatively impact seizure duration during ECT 1
- Mirtazapine has been associated with lower postictal suppression, which does not interfere with ECT efficacy 1
Monitoring Considerations
Seizure Parameters
- Monitor seizure duration closely as mirtazapine generally does not affect seizure duration, while olanzapine may potentially increase it 1, 3
- Pay attention to postictal suppression, which may be lower in patients taking mirtazapine 1
- Document seizure characteristics across sessions to detect any unusual patterns that might require adjustment 2
Potential Side Effects
- Watch for increased sedation or drowsiness, as both medications can cause these effects 5
- Monitor for orthostatic hypotension, particularly with olanzapine 5
- Be vigilant for any signs of delirium or confusion post-ECT, though these are not specifically increased with these medications 6
Clinical Advantages
- Continuing these medications may provide better overall treatment outcomes compared to discontinuing them before ECT 1, 2
- The combination of ECT with these medications may enhance antidepressant efficacy 1
- Maintaining psychiatric medication during ECT helps prevent relapse after the ECT course is completed 2
- Recent evidence (2024) confirms that concomitant psychotropic medication during ECT "does not bare the risk of prolonged seizure duration or reduce the effectiveness of ECT" 2
Medications That Should Be Discontinued Before ECT
Unlike olanzapine and mirtazapine, certain medications should be discontinued prior to ECT:
- Lithium should be discontinued when clinically possible due to risk of acute brain syndrome 7
- Trazodone should be discontinued due to risk of prolonged seizures 7
- Carbamazepine should be discontinued as it may prevent seizure induction 7
- Theophylline should be discontinued as it can prolong seizure duration 7
- Benzodiazepines may need to be tapered or discontinued as they increase seizure threshold 7, 6
Post-ECT Considerations
- After completing the ECT course, continue olanzapine and mirtazapine as part of the maintenance treatment strategy 5
- Systematic assessment of treatment outcomes should include evaluation of cognition, mood, psychosis, and other psychiatric symptoms 5
- Regular follow-up is essential to monitor for mood changes or signs of suicidal ideation for several weeks after ECT 5