Hive-Like Reactions Following ECT Are Not Documented in the Medical Literature
Based on comprehensive guideline reviews and research evidence, hive-like (urticarial) reactions are not listed among the recognized adverse effects of electroconvulsive therapy. This type of reaction does not appear in any of the established complication profiles for ECT.
Documented Adverse Effects of ECT
The well-established adverse effects of ECT fall into distinct categories, none of which include dermatologic or allergic reactions like hives:
Common Acute Side Effects
- Headache, nausea, vomiting, muscle aches, confusion, and agitation are the most frequently reported minor side effects 1, 2
- These symptoms are self-limiting and typically resolve within the day of treatment 1, 2
- Post-ECT headaches can be managed with acetaminophen 1, 3
Cognitive Effects
- Memory impairment and confusion upon awakening are the most common adverse effects, typically clearing within an hour 1
- More persistent memory problems may extend back an average of 6 months, with learning impairment continuing for approximately 2 months after ECT 1, 3
Serious but Uncommon Complications
- Prolonged seizures (lasting >180 seconds) occur in 0-10% of treatments 1, 3
- Tardive seizures are rare, occurring hours after treatment in patients with normal pre-treatment EEGs 1, 3
- Cardiovascular, pulmonary, and cerebrovascular events are uncommon but serious 2, 4
- Status epilepticus is a rare but serious complication 5, 4
- The anesthesia-related mortality rate is 1.1 per 10,000 treatments 1
Clinical Interpretation
If a patient develops hive-like reactions temporally associated with ECT, consider alternative etiologies:
- Anesthesia-related allergic reactions to medications used during the procedure (methohexital, succinylcholine, or other agents)
- Medication reactions to concurrent psychiatric or other medications
- Unrelated dermatologic conditions coincidentally occurring during the treatment course
The absence of dermatologic reactions in the extensive literature on ECT adverse effects—including comprehensive guidelines from the American Academy of Child and Adolescent Psychiatry 1 and systematic reviews 2—strongly suggests this is not a recognized complication of the ECT procedure itself.