Amlodipine and the Successful Management ofPost-Electroconvulsive Therapy Agitation

Electroconvulsive therapy (ECT) is a highly effective nonpharmacologic treatment for the management of depression and someother psychiatric disorders. Post-ECT agitation occurs in up to 12% of ECT treatments and is characterized by motor restlessness,irritability, disorientation, and panic-like behaviors. The severity of post-ECT agitation ranges from mild and self-limited to seriousand severe forms requiring prompt medical intervention to protect the patient and the medical staff. In severe agitation medicalmanagement may be necessary which consists of using sedative agents, either benzodiazepines or propofol. The side-effects of thesesedative agents, especially in the elderly population, necessitate finding ways that could help the prevention of the occurrence ofagitation after ECT treatments. We report a 68-year-old female with major depression who was referred for ECT. She experiencedsevere post-ECT agitation requiring medical intervention after all ECT treatments. Administering of oral amlodipine (5 mg) onehour before ECT treatment successfully prevented the occurrence of post-ECT agitation in this patient. We briefly discuss thepossible underlying mechanisms and pathophysiology of amlodipine in the prevention of post-ECT agitation.