During a course of ECT, seizure duration may become too brief for
clinical benefit. Use of higher-energy stimuli may lengthen seizures but
may also increase the risk of toxicity, and it is not possible when maximum
settings are reached. The authors present the cases of six drug- free
depressed inpatients whose seizure durations in ECT declined despite
maximum settings on three different ECT devices. In all cases, pretreatment
with caffeine lengthened seizures (mean increase = 107%), and clinical
improvement followed. Caffeine was well tolerated, even in patients with
cardiovascular diseases.Abstract Teaser