The Role of Acetylcholinesterase Inhibitors in the Treatment of Prolonged Postelectroconvulsive Therapy Delirium

Overview

Journal Case Rep Psychiatry

Publisher Wiley

Specialty Psychiatry

Date 2022 Jun 9

PMID 35677728

Authors

Brianna Gutowski

Emily Bomasang-Layno

Affiliations

Soon will be listed here.

Abstract

Electroconvulsive therapy (ECT) is an extremely effective treatment modality for severe depression but is often associated with transient or persistent cognitive impairment. ECT-induced cognitive impairment, however, can serve as a deterrent to completion of treatment. We present a case of a prolonged post-ECT delirium lasting approximately 3 weeks in which donepezil, an acetylcholinesterase inhibitor, was used and was successful in shortening the duration of post-ECT delirium.

Citing Articles

ECT and Delirium: Literature Review and a Pediatric Case Report.

Anani A, Reynard H, Ghaziuddin N Curr Psychiatry Rep. 2025; .

PMID: 40075047 DOI: 10.1007/s11920-025-01594-9.

Risk factors for electroconvulsive therapy-induced fever: a retrospective case-control study.

Deng C, Yang J, Liu Z, Ning T, Nie S, Huang X Front Psychiatry. 2025; 15:1530533.

PMID: 39925704 PMC: 11802507. DOI: 10.3389/fpsyt.2024.1530533.

References

Fink M . Post-ECT Delirium. Convuls Ther. 1993; 9(4):326-330. View

Henstra M, Jansma E, Van der Velde N, Swart E, Stek M, Rhebergen D . Acetylcholinesterase inhibitors for electroconvulsive therapy-induced cognitive side effects: a systematic review. Int J Geriatr Psychiatry. 2017; 32(5):522-531. DOI: 10.1002/gps.4702. View

Matthews J, Blais M, Park L, Welch C, Baity M, Murakami J . The impact of galantamine on cognition and mood during electroconvulsive therapy: a pilot study. J Psychiatr Res. 2007; 42(7):526-31. DOI: 10.1016/j.jpsychires.2007.06.002. View

Koola M . Galantamine-Memantine Combination for Cognitive Impairments Due to Electroconvulsive Therapy, Traumatic Brain Injury, and Neurologic and Psychiatric Disorders: Kynurenic Acid and Mismatch Negativity Target Engagement. Prim Care Companion CNS Disord. 2018; 20(2). DOI: 10.4088/PCC.17nr02235. View

Mizrak A, Koruk S, Ganidagli S, Bulut M, Oner U . Premedication with dexmedetomidine and midazolam attenuates agitation after electroconvulsive therapy. J Anesth. 2009; 23(1):6-10. DOI: 10.1007/s00540-008-0695-2. View

Gormley N, Cullen C, Walters L, Philpot M, Lawlor B . The safety and efficacy of electroconvulsive therapy in patients over age 75. Int J Geriatr Psychiatry. 1999; 13(12):871-4. DOI: 10.1002/(sici)1099-1166(1998120)13:12<871::aid-gps887>3.0.co;2-k. View

Ittasakul P, Jarernrat P, Tor P . Prevalence and Predictors of Postictal Confusion After Electroconvulsive Therapy. Neuropsychiatr Dis Treat. 2021; 17:283-289. PMC: 7866936. DOI: 10.2147/NDT.S281961. View

Selvaraj A, Praharaj S . Delayed onset and prolonged interictal delirium following electroconvulsive therapy. Psychogeriatrics. 2012; 12(3):211-3. DOI: 10.1111/j.1479-8301.2012.00419.x. View

Andrade C, Arumugham S, Thirthalli J . Adverse Effects of Electroconvulsive Therapy. Psychiatr Clin North Am. 2016; 39(3):513-30. DOI: 10.1016/j.psc.2016.04.004. View

10.

Wengel S, Roccaforte W, BURKE W . Donepezil improves symptoms of delirium in dementia: implications for future research. J Geriatr Psychiatry Neurol. 1999; 11(3):159-61. DOI: 10.1177/089198879801100308. View

11.

van Schaik A, Rhebergen D, Henstra M, Kadouch D, van Exel E, Stek M . Cognitive Impairment and Electroconvulsive Therapy in Geriatric Depression, What Could be the Role of Rivastigmine? A Case Series. Clin Pract. 2015; 5(3):780. PMC: 4653751. DOI: 10.4081/cp.2015.780. View

12.

Augoustides J, Greenblatt E, Abbas M, OReardon J, Datto C . Clinical approach to agitation after electroconvulsive therapy: a case report and literature review. J ECT. 2002; 18(4):213-7. DOI: 10.1097/00124509-200212000-00009. View

13.

Jo Y, Joo S, Lee J, Joo Y . Factors associated with post-electroconvulsive therapy delirium: A retrospective chart review study. Medicine (Baltimore). 2021; 100(14):e24508. PMC: 8036032. DOI: 10.1097/MD.0000000000024508. View

14.

Martin D, Galvez V, Loo C . Predicting Retrograde Autobiographical Memory Changes Following Electroconvulsive Therapy: Relationships between Individual, Treatment, and Early Clinical Factors. Int J Neuropsychopharmacol. 2015; 18(12). PMC: 4675978. DOI: 10.1093/ijnp/pyv067. View

15.

Niu Y, Ye D, You Y, Wu J . Prophylactic cognitive enhancers for improvement of cognitive function in patients undergoing electroconvulsive therapy: A systematic review and meta-analysis. Medicine (Baltimore). 2020; 99(11):e19527. PMC: 7440112. DOI: 10.1097/MD.0000000000019527. View

16.

Grover S, Kumar A, Chakrabarti S, Avasthi A . The incidence of prolonged post-electroconvulsive therapy delirium: A retrospective study. Indian J Psychiatry. 2020; 62(2):193-197. PMC: 7197832. DOI: 10.4103/psychiatry.IndianJPsychiatry_553_19. View

17.

Reti I, Krishnan A, Podlisky A, Sharp A, Walker M, Neufeld K . Predictors of electroconvulsive therapy postictal delirium. Psychosomatics. 2013; 55(3):272-9. DOI: 10.1016/j.psym.2013.03.004. View

18.

Lerer B . Studies on the role of brain cholinergic systems in the therapeutic mechanisms and adverse effects of ECT and lithium. Biol Psychiatry. 1985; 20(1):20-40. DOI: 10.1016/0006-3223(85)90132-5. View

19.

Prakash J, Kotwal A, Prabhu H . Therapeutic and prophylactic utility of the memory-enhancing drug donepezil hydrochloride on cognition of patients undergoing electroconvulsive therapy: a randomized controlled trial. J ECT. 2006; 22(3):163-8. DOI: 10.1097/01.yct.0000230365.81368.2d. View

20.

Sackeim H, Prudic J, Devanand D, Kiersky J, Fitzsimons L, Moody B . Effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. N Engl J Med. 1993; 328(12):839-46. DOI: 10.1056/NEJM199303253281204. View