Safety of Electroconvulsive Therapy in Patients Receiving Dabigatran Therapy

Abstract

Received March 26, 2013; revised June 10, 2013; accepted June 11, 2013. From Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN; Department of Medicine, Mayo Clinic, Rochester, MN; Department of Pharmacy, Mayo Clinic, Rochester, MN; Department of Nursing, Mayo Clinic, Rochester, MN; Department of Medicine, Mayo Clinic, Jacksonville, FL. Send correspondence and reprint requests to Maria I. Lapid, M.D., Mayo Clinic Dept. of Psychiatry and Psychology, 200 First Street SW, Rochester, MN 55905; e-mail: lapid.maria@ mayo.edu & 2014 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved. Electroconvulsive therapy (ECT) is used to treat several psychiatric disorders, including depression, mania, catatonia, and psychosis. ECT is generally thought to be a very safe and effective procedure. There is an estimated mortality of 2–4 per 100,000 patients treated in the United States; complications are comparable to those expected with use of anesthesia, and there are no absolute contraindications to ECT. During ECT, there is a transient increase in systemic and intracerebral blood pressure and tachycardia. Owing to concerns for intracerebral hemorrhage, previous studies have investigated the potential for adverse events in patients who were treated with ECT and receiving the anticoagulant medication warfarin. These studies have demonstrated the safety of ECT in patients who are also taking warfarin. Also, one study demonstrated that patients treated with selective serotonin reuptake inhibitors (SSRIs) and warfarin may be at an increased risk for bleeding, and additionally, Schellman and associates demonstrated that patients treated with warfarin with the addition of citalopram, fluoxetine, paroxetine, amitriptyline, or mirtazapine are at an increased risk for hospital admissions for gastrointestinal bleeding. Warfarin has a narrow therapeutic range, and levels are easily influenced by food intake and drug interactions. Despite these barriers, studies have shown that patients can undergo ECT safely when anticoagulated in the therapeutic range.One case serieswith 35patients failed to show adverse events or safety concerns in those who were receiving ECT and taking warfarin. Recent developments in anticoagulation therapy include several new drugs approved and used as