Clinical Geriatrics

To the Editor:

I am writing regarding Dr. Lantz’s article from the December 2008 issue of Clinical Geriatrics.1 As a highly experienced psychiatrist who has performed thousands of electroconvulsive therapies (ECTs), I take exception to your sweeping statements which suggest to the uninitiated that ECT will be ineffective if the patient is taking a benzodiazepine or an anticonvulsant. Your heading for Table II is more accurate. It is misleading to say in the body of the table that those types of medications “will” interfere. In fact, ECT can often be effective in spite of such meds.

Lee C. Miller, MD
Harrisburg, PA

Reference

1. Lantz MS. Electroconvulsive therapy: When stigma delays use of an effective treatment. Clinical Geriatrics 2008;16(12):10-13.

Dr. Lantz responds:

I would like to thank Dr. Miller for clarifying an important issue. There are no absolute contraindications to electroconvulsive therapy.1,2 There are always relevant issues related to the medical status, prior history, and current medication use that are very relevant to the anesthesiologist and psychiatrist who will be performing the procedure. The use of anticonvulsants does raise the seizure threshold, and may require adjustments in the administration of the stimulus during therapy.2 Obtaining a thorough and accurate medication history is always of value in patient care, and I encourage clinicians to continue to pursue this.

Melinda S. Lantz, MD
Chief of Geriatric Psychiatry
Beth Israel Medical Center
New York, NY

References

1. Fink M. What is electroconvulsive therapy. In: Fink M, ed. Electroconvulsive Therapy: A Guide for Professionals and Their Patients. New York: Oxford University Press; 2009:3-9.

2. Beyer JL, Weiner RD, Glenn MD. Patient referral and evaluation. In: Beyer JL, Weiner RD, Glenn MD, eds. Electroconvulsive Therapy: A Programmed Text. 2nd ed. Washington, DC: American Psychiatric Press, Inc.; 1998:25-36.