Does Valproate Interfere with ECT?

It is standard practice to discontinue anticonvulsants during electroconvulsive therapy (ECT) on the grounds that these medications raise the seizure threshold and thus interfere with ECT's therapeutic effect. In this randomized, double-blind study from Iran, 42 hospitalized manic patients (mean age, 32) who were taking valproate for at least 5 days (minimum dose, 750 mg; serum level, 50–150 µg/dL) either continued the same valproate dose or were switched to placebo. Patients then began bifrontal ECT three times weekly.

Valproate and placebo groups were clinically similar and received a similar mean number of ECTs (8 and 7 sessions, respectively). After 6 ECTs, mean mania rating scale scores decreased by 42% and 48% in valproate and placebo …