THE USE OF FLUMAZENIL IN THE ANXIOUS AND BENZODIAZEPINE-DEPENDENT ECTPATIENT

Many patients who receive electroconvulsive therapy (ECT) are benzodia zepine dependent or are anxious and require benzodiazepine drugs. Beca use these agents may diminish the therapeutic effectiveness of ECT, we explored the dosing, safety, and efficacy of pre-ECT flumazenil admin istration, a benzodiazepine-competitive antagonist, in patients receiv ing benzodiazepine medications. We report our experience with 35 patie nts who received both flumazenil and benzodiazepine drugs during their ECT course. We compared seizure duration with and without flumazenil and compared treatment efficacy to 49 patients who received ECT withou t either of these medications. Flumazenil could be safely administered with ECT. A few subjects taking higher chronic benzodiazepine dosages experienced breakthrough anxiety or withdrawal symptoms, which were w ell managed by dosing flumazenil immediately before the anesthetic age nt and by immediate posttreatment benzodiazepine administration. A dos e of 0.4-0.5 mg was adequate for all but those taking the highest benz odiazepine dosages, where 0.8-1.0 mg resulted in a clinically more eff ective reversal. No differences in efficacy or seizure duration were f ound as a function of flumazenil administration. Flumazenil offers the promise of safe and effective ECT in patients receiving benzodiazepin e drugs. Follow-up outcome investigation on a random assignment basis will be necessary for definitive assessment of the value of flumazenil . In addition, the direct effect of benzodiazepine drugs and the fluma zenil/benzodiazepine combination on ECT seizures remains to be determi ned.