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Originally Posted by janism Mike, et. al., One other observation I'd offer here is that I also began to notice that I would react very quickly to things that prior to this wouldn't have bothered me at all - it was as if I'd developed an anger response "hair trigger" over what were often the most trivial things. All of a sudden I'd just flash really angry - to the point that I would think now why in the world would that (whatever "that" might have been at the moment) have made me angry, much less THIS angry?! Just a curious reaction I thought I'd pass along ...

Propofol for the management of emergence agitation after electroconvulsive therapy: review of a case series, O'Reardon JP, Takieddine N, Datto CJ, Augoustides JG, J ECT 2006 Dec;22(4):247-52

ECT Service and Training Program, Department of Psychiatry, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. oreardon@mail.med.upenn.edu

We report the successful use of propofol in the management of a case series (n = 10) of patients with severe, treatment-resistant, postictal agitation (PIA) in the setting of electroconvulsive therapy (ECT). Despite prior inadequate response to intravenous midazolam and other agents, propofol therapy was highly effective with good control of PIA achieved in all cases. Propofol was well tolerated with occasional, transient, and reversible drops in blood the pressure being the only adverse event noted.The administration of propofol was also versatile being effective, as either a bolus or a bolus followed by an infusion. It appeared to be synergistic with existing therapy. Although further study is needed, these results suggest that propofol may be a very valuable additional agent for the ECT clinician in the management of PIA, which is a common entity in the setting of ECT.

Promethazine for the treatment of agitation after electroconvulsive therapy: a case series, Vishne T, Amiaz R, Grunhaus L, J ECT 2005 Jun;21(2):118-21.

Division of Psychiatry Sheba Medical Center, Israel. tali@vishne.com

OBJECTIVES: Agitation after electroconvulsive therapy (ECT) is observed in approximately 7% of patients. Promethazine is an antihistamine with sedative properties that has no antiseizure effects and therefore can be administered before ECT to prevent the onset of agitation. In the current study, we present a series of 8 patients who reacted to ECT with severe agitation and improved under the treatment of promethazine.

METHODS: Eight patients were included (5 women, 3 men), ages 22 to 77 years. All patients showed severe post-ECT agitation as demonstrated by severe restlessness, crying, or mumbling loudly. Seven of them required the administration of intravenous midazolam. ECT was given according to established clinical protocols at the Sheba Medical Center. All patients were prescribed either 25 to 50 mg of promethazine 2 hours before the treatment to avoid agitation.

RESULTS: All 8 patients suffered from extreme agitation after ECT treatment, and 7 required the administration of intravenous midazolam. After a clinical protocol, these patients were prescribed 25-50 mg of promethazine orally 60-120 minutes before the ECT. Improvement was observed in all patients both immediately post-ECT and also in their overall sense of well-being after the ECT. No patient complained of adverse reactions to the promethazine. Most patients reported a relief in pre-ECT fears.

CONCLUSION: In this small case series, we found that promethazine can be used to prevent post-ECT agitation. Further double-blind controlled studies are needed to better evaluate the usefulness and appropriateness of promethazine in the prevention of pre-ECT fears and post-ECT agitation.