PHARMACODYNAMIC INTERACTIONS AND CLINICAL MANAGEMENT OF PSYCHOTROPIC MEDICATIONS DURING ELECTROCONVULSIVE THERAPY
DOI:
https://doi.org/10.22159/ijap.2026v18i4.57118Keywords:
Benzodiazepines, Serotonin, Dopamine, Neuroplasticity, Depression, Catatonia, SchizophreniaAbstract
The aim of this study was to analyze clinical approaches to psychotropic medication management during electroconvulsive therapy (ECT), focusing on dose adjustment and clinically relevant treatment-related risks, using illustrative clinical cases. A narrative review of 26 publications published between 2019 and 2025 was conducted, identifying and analyzing six illustrative clinical cases from four peer-reviewed articles describing the combined use of ECT and psychotropic pharmacotherapy. Analysis of six clinical cases revealed substantial heterogeneity in psychiatric diagnoses, psychotropic drug classes, dosing regimens, and ECT parameters. No consistent or unified approach to dose adjustment during ECT was identified across cases. Benzodiazepine management varied. The dose reduction was observed in two cases, dose escalation was noted in one case, and complete discontinuation was in one case. Escalation of serotonergic medications during ECT was associated with serotonin syndrome in one case, whereas stable serotonergic dosing without ECT in two cases was not accompanied by serotonergic toxicity. The findings indicate that psychotropic medication management during electroconvulsive therapy is predominantly individualized and guided by patients’ clinical status, seizure characteristics, and treatment tolerability rather than by standardized pharmacodynamic algorithms. These results may be used by psychiatrists and anesthesiologists to support cautious clinical decision-making when combining electroconvulsive therapy with psychotropic medications and to inform the design of future prospective studies on medication management during ECT.
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