Oral theophylline augmentation for patients with missed or inadequate seizures with electroconvulsive therapy

An inadequate seizure occasionally occurs during a course of acute electroconvulsive therapy (ECT) under the maximum approved electrical stimulation in Japan of 504 mC. This retrospective study was conducted to determine the effectiveness and adverse reactions of an oral theophylline augmentation technique. A retrospective review of medical records was conducted of patients admitted to the Department of Psychiatry, Hiroshima Citizens Hospital, who received acute phase ECT from October 2014 to March 2017. A theophylline augmentation technique was instituted in 13 patients (7 males, 6 females; 56–79 years old). The total number of ECT sessions per patient ranged from 9 to 20 and the number of those with theophylline augmentation per patient ranged from 1 to 17. An augmentation effect was noted in all patients and each finished the scheduled ECT course, except for 1 who developed memory disturbance. The maximum dose of theophylline ranged from 200 to 700 mg/day, and the serum level at 06:00 on the day of the ECT session ranged from 5.3 to 23.6 mg/L in 12 patients, as 1 missed the examination. Oral theophylline augmentation can be considered as an effective treatment option for patients undergoing ECT with inadequate seizures. •An adequate augmentation technique is frequently required for patients undergoing ECT in clinical settings.•Oral theophylline augmentation can be considered as an effective treatment option for patients with inadequate seizures.•No previous study has directly assessed whether addition of theophylline improves seizure adequacy and clinical response.