Should lithium and ECT be used concurrently in geriatric patients?
What we recommend
Possible interactions between lithium and ECT that lead to ECT-associated delirium need further elucidation, but discontinuing lithium during the course of ECT in a geriatric patient warrants your consideration. Following a safe interval after the last ECT session, lithium likely can be safely re-introduced 1) if there is clinical need and 2) as long as clinical surveillance for cognitive side effects is provided— especially if ECT will need to be reconsidered in the future.
Two additional considerations:
• Actively reassess lithium dosing in all geriatric psychiatric patients, especially those with renal insufficiency and other systemic metabolic considerations.
• Actively examine the use of all other anticholinergic agents in the course of evaluating a patient’s candidacy for ECT.
Disclosures
The authors report no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.
