The Journal of clinical psychiatry
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Randomized Controlled Trial Clinical Trial
Labetalol in the control of cardiovascular responses to electroconvulsive therapy in high-risk depressed medical patients.
Labetalol, a drug with alpha- and beta-adrenergic receptor blocking effects, was used to attenuate hypertension and tachycardia associated with electroconvulsive therapy (ECT) in a series of 11 elderly patients with refractory depression and cardiovascular disease in a placebo-controlled, double-blind crossover study design. As compared with placebo, labetalol was found to blunt mean arterial pressure (MAP) increase by up to 8.26% (p less than .001), heart rate increased by up to 26.07% (p less than .001), frequency of atrial arrhythmias by up to 100% (p less than .01), and premature ventricular contractions by 41.97%. No untoward side effects were observed, and no effect on treatment outcome was noted. Labetalol appears to be an effective and safe agent to use in decreasing hypertension, tachycardia, and possibly arrhythmias in high-risk medical patients with cardiovascular disease undergoing ECT.
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The lifelong nature of panic disorder and the development of effective new treatments have focused attention on long-term use of antipanic medications, particularly benzodiazepines and their possibly addictive nature. Benzodiazepines are generally safe and effective. An understanding of the distinction between chemical dependence and physical dependence places problems involved in the use and discontinuation of benzodiazepines into perspective. ⋯ Others may develop physical dependence but are able to discontinue benzodiazepine treatment when panic symptoms subside. The approach to benzodiazepine use and discontinuation should be different for patients with chemical dependence as opposed to patients with physical dependence. A four-step approach to discontinuation that is applicable to both groups is offered.