Beta-blockers for electroconvulsive therapy: A systematic review and meta-analysis
- PMID: 40015235
- DOI: 10.1016/j.jpsychires.2025.01.059
Beta-blockers for electroconvulsive therapy: A systematic review and meta-analysis
Abstract
Electroconvulsive therapy (ECT) is an established treatment for various mental disorders. However, ECT can induce significant haemodynamic fluctuations, raising safety concerns. This systematic review and meta-analysis aimed to evaluate the effects of adding beta-blockers to ECT on maximum heart rate after stimulation and the occurrence of adverse events. Only randomised controlled trials (RCTs) that compared the addition of beta-blockers to ECT with treatment as usual (TAU), such as placebo added to ECT or ECT without antihypertensive or antiarrhythmic medications, were included. The primary outcomes were maximum heart rate and the percentage of patients who experienced adverse events after stimulation. A total of 31 publications (33 studies, 42 comparisons, 1476 participants) were included. The beta-blocker group showed a significant reduction in maximum heart rate after stimulation compared to TAU group (28 publications, 29 studies, 38 comparisons, n = 1,375, mean difference (MD) = 21.98, 95% CI 17.94-26.02, p < 0.01). Significant differences were maintained in subgroup and sensitivity analyses. Furthermore, there was no significant increase in the risk of adverse events after stimulation compared to TAU group (20 publications, 21 studies, 27 comparisons, n = 1,014, RR = 1.44, 95% CI 0.93-2.25, p = 0.11). This is the first meta-analysis to assess the cardiovascular effects of beta-blockers during ECT. It demonstrated that the addition of beta-blockers to ECT may stabilise heart rate after stimulation without increasing adverse events. These results suggest that the addition of beta blockers may benefit high-risk patients who experience difficulty continuing ECT due to adverse events such as arrhythmias or tachycardia after stimulation.
Keywords: Beta-blocker; Electroconvulsive therapy; Heart rate; Hemodynamics; Meta-analysis; Seizure duration; Systematic review.
Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.
Conflict of interest statement
Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Toshiyuki Shimizu reports a relationship with Meiji Seika Pharma Co Ltd that includes: speaking and lecture fees. Toshiyuki Shimizu reports a relationship with Sumitomo Pharma Co Ltd that includes: speaking and lecture fees. Toshiyuki Shimizu reports a relationship with Janssen Pharmaceutical KK that includes: speaking and lecture fees. Toshiyuki Shimizu reports a relationship with Mochida Pharmaceutical Co Ltd that includes: speaking and lecture fees. Yoshiteru Takekita reports a relationship with Japan Society for the Promotion of Science that includes: funding grants. Yoshiteru Takekita reports a relationship with Meiji Seika Pharma Co Ltd that includes: speaking and lecture fees. Yoshiteru Takekita reports a relationship with Sumitomo Pharma Co Ltd that includes: speaking and lecture fees. Yoshiteru Takekita reports a relationship with Janssen Pharmaceutical KK that includes: speaking and lecture fees. Yoshiteru Takekita reports a relationship with Otsuka Pharmaceutical Co Ltd that includes: speaking and lecture fees. Yoshiteru Takekita reports a relationship with Eisai Co Ltd that includes: speaking and lecture fees. Yoshiteru Takekita reports a relationship with MSD KK that includes: speaking and lecture fees. Yoshiteru Takekita reports a relationship with Daiichi Sankyo Inc that includes: speaking and lecture fees. Yoshiteru Takekita reports a relationship with Pfizer that includes: speaking and lecture fees. Yoshiteru Takekita reports a relationship with UCB Japan Co Ltd that includes: speaking and lecture fees. Yoshiteru Takekita reports a relationship with Takeda Pharmaceutical Company Limited that includes: speaking and lecture fees. Nobuatsu Aoki reports a relationship with Japan Society for the Promotion of Science that includes: funding grants. Nobuatsu Aoki reports a relationship with Meiji Seika Pharma Co Ltd that includes: speaking and lecture fees. Nobuatsu Aoki reports a relationship with Lundbeck Japan KK that includes: speaking and lecture fees. Nobuatsu Aoki reports a relationship with Sumitomo Pharma Co Ltd that includes: speaking and lecture fees. Taro Suwa reports a relationship with Shionogi and Co Ltd that includes: funding grants. Taro Suwa reports a relationship with EA Pharma Co Ltd that includes: speaking and lecture fees. Taro Suwa reports a relationship with Otsuka Pharmaceutical Co Ltd that includes: speaking and lecture fees. Taro Suwa reports a relationship with Lundbeck Japan kk that includes:. Taro Suwa reports a relationship with Merck Sharp & Dohme that includes: speaking and lecture fees. Taro Suwa reports a relationship with Sumitomo Pharma Co Ltd that includes: speaking and lecture fees. Taro Suwa reports a relationship with Takeda Pharmaceutical Company Limited that includes: speaking and lecture fees. Taro Suwa reports a relationship with Tsumura & Co that includes: speaking and lecture fees. Kazuyuki Yasuda reports a relationship with Sumitomo Pharma Co Ltd that includes: speaking and lecture fees. Kazuyuki Yasuda reports a relationship with Otsuka Pharmaceutical Co Ltd that includes: speaking and lecture fees. Kazuyuki Yasuda reports a relationship with Eisai Co Ltd that includes: speaking and lecture fees. Kazuyuki Yasuda reports a relationship with Viatris Inc that includes: speaking and lecture fees. Kazuyuki Yasuda reports a relationship with Medic Media Corporation that includes: speaking and lecture fees. Nina Uchinuma reports a relationship with Otsuka Pharmaceutical Co Ltd that includes: speaking and lecture fees. Nina Uchinuma reports a relationship with Lundbeck Japan kk that includes: speaking and lecture fees. Nina Uchinuma reports a relationship with Sumitomo Pharma Co Ltd that includes: speaking and lecture fees. Nina Uchinuma reports a relationship with Takeda Pharmaceutical Company Limited that includes: speaking and lecture fees. Nina Uchinuma reports a relationship with Kyowa Pharmaceutical Industry Co Ltd that includes: speaking and lecture fees. Yuki Kojima reports a relationship with Otsuka Pharmaceutical Co Ltd that includes: speaking and lecture fees. Yuki Kojima reports a relationship with Sumitomo Pharma Co Ltd that includes: speaking and lecture fees. Yuki Kojima reports a relationship with Lundbeck Japan kk that includes: speaking and lecture fees. Hirotsugu Kawashima reports a relationship with Meiji Seika Pharma Co Ltd that includes: speaking and lecture fees. Hirotsugu Kawashima reports a relationship with Sumitomo Pharma Co Ltd that includes: speaking and lecture fees. Hirotsugu Kawashima reports a relationship with Lundbeck Japan kk that includes: speaking and lecture fees. Hirotsugu Kawashima reports a relationship with Mochida Pharmaceutical Co Ltd that includes: speaking and lecture fees. Masaki Kato reports a relationship with Japan Agency for Medical Research and Development that includes: funding grants. Masaki Kato reports a relationship with the Japanese Ministry of Health, Labour and Welfare, that includes: funding grants. Masaki Kato reports a relationship with Japan Society for the Promotion of Science that includes: funding grants. Masaki Kato reports a relationship with Senshin Medical Research Foundation that includes: funding grants. Masaki Kato reports a relationship with Japan Research Foundation for Clinical Pharmacology that includes: funding grants. Masaki Kato reports a relationship with the Japanese Society of Clinical Neuropsychopharmacolog that includes: funding grants. Masaki Kato reports a relationship with Sumitomo Pharma Co Ltd that includes: consulting or advisory and speaking and lecture fees. Masaki Kato reports a relationship with Shionogi and Co Ltd that includes: consulting or advisory and speaking and lecture fees. Masaki Kato reports a relationship with Otsuka Pharmaceutical Co Ltd that includes: consulting or advisory and speaking and lecture fees. Masaki Kato reports a relationship with Lundbeck Japan KK that includes: consulting or advisory and speaking and lecture fees. Masaki Kato reports a relationship with Takeda Pharmaceutical Company Limited that includes: consulting or advisory and speaking and lecture fees. Masaki Kato reports a relationship with Meiji Seika Pharma Co Ltd that includes: speaking and lecture fees. Masaki Kato reports a relationship with Mitsubishi Tanabe Pharma Corporation that includes: speaking and lecture fees. Masaki Kato reports a relationship with Viatris Inc that includes: speaking and lecture fees. Masaki Kato reports a relationship with Eisai Co Ltd that includes: speaking and lecture fees. Masaki Kato reports a relationship with Kyowa Pharmaceutical Industry Co Ltd that includes: speaking and lecture fees. Aran Tajika reports a relationship with Eisai Co Ltd that includes: speaking and lecture fees. Aran Tajika reports a relationship with Shionogi and Co Ltd that includes: speaking and lecture fees. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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