Factors Associated with Delirium following Electroconvulsive Therapy: A Systematic Review

Takashi Tsujii, Takahito Uchida, Takefumi Suzuki, Masaru Mimura, Jinichi Hirano, Hiroyuki Uchida

Research output: Contribution to journalReview articlepeer-review

25 Citations (Scopus)


Objectives Delirium following electroconvulsive therapy (ECT) has been a clinical challenge, which, however, has not been investigated through a systematic literature review. The objective of this study was to systematically synthesize available evidence regarding factors associated with post-ECT delirium. Methods We conducted a systematic literature search for any type of original investigations that reported risk factors of post-ECT delirium, using PubMed. Results The literature search identified 43 relevant articles. One study found an association between catatonic feature and increased risk of postictal delirium. Five studies reported that the presence of cerebrovascular disease, Parkinson disease, or dementia was related to higher incidence of post-ECT delirium. Incidence of post-ECT course delirium was increased with bitemporal stimulation (3 studies). One study showed that ultrabrief pulse ECT reduced reorientation time following seizure compared with brief pulse ECT. High stimulus intensity resulted in more prolonged reorientation time after ECT than lower stimulus intensity (2 studies). Longer seizure length was significantly associated with post-ECT delirium in 1 study. Eight studies that examined postictal delirium in association with medications used, including lithium, did not show any consistent finding in their relationships. Four studies showed decreased incidence of postictal delirium in those receiving dexmedetomidine. Conclusions Limited evidence suggests that catatonic feature, cerebrovascular disease, Parkinson disease, dementia, bitemporal electrode placement, high stimulus intensity, or longer seizure length are associated with an increased risk of post-ECT delirium. Moreover, dexmedetomidine and ultrabrief pulse ECT seem to have preventive effects of post-ECT delirium.

Original languageEnglish
Pages (from-to)279-287
Number of pages9
JournalJournal of ECT
Issue number4
Publication statusPublished - 2019 Dec 1


  • delirium
  • dexmedetomidine
  • electroconvulsive therapy
  • lithium
  • systematic review

ASJC Scopus subject areas

  • Neuroscience (miscellaneous)
  • Psychiatry and Mental health


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