Delirium with Concurrent Use of Lithium and ECT and the Safety Implications: Case Reports and Review of the Literature

Table 1

Lithium-ECT induced delirium.

Sl no	Author(s) and year	Type of study (no. of cases)	Serum lithium	Comments
1	Jephcott and Kerry (1974) [28]	Case report (1)	3.4 mEq/L	Developed somnolence and lethargy after 2nd ECT [28]
2	Ray (1975) [29]	Case report (1)	0.46 mEq/L	Developed delirium after 3rd ECT [29]
3	Hoenig and Chaulk (1977) [30]	Case report (1)	1.09 mEq/L	Developed severe confusion after 1st ECT [30]
4	Zwil et al. [31]	Case report (1)	NA	Developed confusion and cognitive impairment [31]
5	Remick (1978) [32]	Case report (1)	1.0	Developed delirium after 4th ECT [32]
6	Mandel et al. (1980) [33]	Case report (2)	0.98 mEq/L and 0.60 mEq/L	(a) Developed prolonged confusion after 3rd ECT; (b) Developed confusion after 2nd ECT [33]
7	Weiner et al. (1980) [34]	Case report (1)	0.37 mEq/L	Developed delirium after 5th ECT [34]
8	Small et al. [14]	Retrospective Chart Review (25)	NA	ECT/Li patients compared with age-matched controls receiving ECT without Li. The combination group had more confusion and memory impairment on chart review [14]
9	De Paulo et al. [35]	Case report (1)	0.8 mEq/L	Li started after 4th ECT—delirium ensued [35]
10	Ahmed and Stein (1987) [36]	Case report (1)	Normal S.Li level	Developed confusion after 2nd ECT [36]
11	Sartorius et al. [13]	Chart review (7)	NA	1 patient developed prolonged disorientation after ECT [13]
12	Penney et al. (1990) [37]	Chart review (27)	NA	Patients in the ECT+Li groups developed more post ECT confusion than the ECT group [37]
13	Jha AK (1996) [38]	Retrospective case-control (31)	NA	10% of patients developed delirium [38]
14	Stewart [39]	Case report (1)	NA	Developed increase in confusion while on combination of ECT and lithium [39]
15	Hassamal et al. (2013) [40]	Case report (1)	<0.3 mEq/L	Developed delirium after 3rd ECT [40]
16	Sadananda et al. (2013) [15]	Case report (1)	0.9 mEq/L	Developed delirium after 6th ECT [15]
17	Hategan and Bourgeois (2014) [41]	Case report (1)	0.3 mEq/L	Developed delirium after 1st and 2nd ECT [41]
18	Deuschle et al. [42]	Case report (1)	0.12 mEq/L	Developed delirium 2 days after starting lithium after 5th ECT [42]
19	Patel et al. [8]	Retrospective case-control (34)	NA	5.7% of patients developed acute delirium; 2.4% of patients developed cognitive impairment [8]
20	Jo et al. (2021) [43]	Retrospective chart review (1)	NA	1 of 6 patients on lithium developed acute delirium after ECT [43]
21	Yang et al. (2022) [44]	Case report (1)	1.21 mEq/L	Developed delirium after 9th ECT [44]