Electroconvulsive therapy considerations for transgendered patients

Billy K. Tran, Stephen E. O'Donnell, Agnes Balla, David C. Adams, Lydia S. Grondin, Mitchell H. Tsai

Research output: Contribution to journalArticle

Abstract

As the transgender patient population continues to grow, health care providers will need to become aware of elements unique to the transgender community in order to provide the highest quality of care. Neuromuscular blockade with succinylcholine is routinely administered to patients undergoing electroconvulsive therapy (ECT). Decreased amounts or activity of pseudocholinesterase in serum can lead to prolonged duration of muscle paralysis. Causes of reduced action by pseudocholinesterase include genetically abnormal enzymes, reduced hepatic production, pregnancy, and various drug interactions. Estrogen supplementation taken by transitioning patients may affect the duration of neuromuscular blockade. This is a case of a 32-year-oldmale-to-female transgender patient with prolonged apnea following ECT treatment for severe, refractory depression. Further investigation revealed the patient was on estrogen therapy as a part of her transition and laboratory testing demonstrated reduced serum pseudocholinesterase activity. Further laboratory testing demonstrated reduced serum pseudocholinesterase activity. Succinylcholine dosing was titrated to an appropriate level to avoid prolonged apnea in subsequent ECT treatments. Physicians and other health care providers are faced with a unique population in the transgender community and must be aware of distinctive circumstanceswhen providing care to this group.Of specific interest,many transitioning and transitioned patients can be on chronic estrogen supplementation. Neuromuscular blockade in those patients require attention from the anesthesiology care team as estrogen compounds may decrease pseudocholinesterase levels and lead to prolonged muscle paralysis from succinylcholine.

Original languageEnglish (US)
Pages (from-to)e14-e16
JournalJournal of ECT
Volume33
Issue number2
DOIs
StatePublished - Jan 1 2017
Externally publishedYes

Fingerprint

Transgender Persons
Electroconvulsive Therapy
Pseudocholinesterase
Neuromuscular Blockade
Succinylcholine
Estrogens
Apnea
Paralysis
Health Personnel
Serum
Treatment-Resistant Depressive Disorder
Muscles
Anesthesiology
Quality of Health Care
Drug Interactions
Population
Therapeutics
Physicians
Pregnancy
Liver

Keywords

  • Apnea
  • Estrogen
  • Neuromuscular blockage
  • Transgender

ASJC Scopus subject areas

  • Neuroscience (miscellaneous)
  • Psychiatry and Mental health

Cite this

Tran, B. K., O'Donnell, S. E., Balla, A., Adams, D. C., Grondin, L. S., & Tsai, M. H. (2017). Electroconvulsive therapy considerations for transgendered patients. Journal of ECT, 33(2), e14-e16. https://doi.org/10.1097/YCT.0000000000000371

Electroconvulsive therapy considerations for transgendered patients. / Tran, Billy K.; O'Donnell, Stephen E.; Balla, Agnes; Adams, David C.; Grondin, Lydia S.; Tsai, Mitchell H.

In: Journal of ECT, Vol. 33, No. 2, 01.01.2017, p. e14-e16.

Research output: Contribution to journalArticle

Tran, BK, O'Donnell, SE, Balla, A, Adams, DC, Grondin, LS & Tsai, MH 2017, 'Electroconvulsive therapy considerations for transgendered patients', Journal of ECT, vol. 33, no. 2, pp. e14-e16. https://doi.org/10.1097/YCT.0000000000000371
Tran, Billy K. ; O'Donnell, Stephen E. ; Balla, Agnes ; Adams, David C. ; Grondin, Lydia S. ; Tsai, Mitchell H. / Electroconvulsive therapy considerations for transgendered patients. In: Journal of ECT. 2017 ; Vol. 33, No. 2. pp. e14-e16.
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