Augmentation of Electroconvulsive Therapy with Oral Caffeine: A Retrospective Analysis of 40 Patients with Major Depression.

Objective: Studies have demonstrated the efficacy of injectable caffeine as an augmentation method in electroconvulsive therapy (ECT). This study investigated whether orally administered caffeine increases seizure duration during ECT.

Methods: Medical records of 40 patients treated with a series of ECT were retrospectively analyzed. Patients whose electroencephalogram (EEG) seizure duration had dropped<30 s, or motor seizure duration<15 s were included. They subsequently received oral caffeine (0.2 g) before ECT sessions. Primary outcomes were EEG seizure duration and motor seizure duration, compared with those from the last pre-caffeine session (baseline) and the first five caffeine-augmented sessions. The mental state was assessed with the Global Assessment of Functioning (GAF). In addition, data on maximum heart rate, maximal arterial pressure, and adverse effects were collected.

Results: The EEG seizure duration increased by 14.9 s (52%) on average between baseline and the first caffeine-augmented session. The increased length remained widely stable over the subsequent ECT sessions. EEG seizure duration was>30 s in more than 80% of sessions. A statistically significant increase in motor seizure duration appeared only in the 2^nd and 3^rd of five sessions with augmentation. Oral caffeine pretreatment was overall well tolerated. The percentage of patients with at least serious mental impairment (GAF score≤50) dropped from 77.5 to 15%.

Conclusions: Results suggest the utility of oral caffeine (0.2 g) to increase ECT-induced seizures in patients with durations below clinically significant thresholds.