thiopental and Bipolar-Disorder

Studies now provide strong evidence that the N-methyl-D-aspartate receptor antagonist ketamine possesses rapidly acting antidepressant properties. This study aimed to determine if a low dose of ketamine could be used to expedite and augment the antidepressant effects of electroconvulsive therapy (ECT) treatments in patients experiencing a severe depressive episode.. Subjects with major depressive disorder or bipolar disorder referred for ECT treatment of a major depressive episode were randomized to receive thiopental alone or thiopental plus ketamine (0.5 mg/kg) for anesthesia before each ECT session. The Hamilton Depression Rating Scale (HDRS) was administered at baseline and at 24 to 72 hours after the first and sixth ECT sessions.. Electroconvulsive therapy exerted a significant antidepressant effect in both groups (F2,24 = 14.35, P < 0.001). However, there was no significant group effect or group-by-time interaction on HDRS scores. In addition, post hoc analyses of the time effect on HDRS showed no significant HDRS reduction after the first ECT session for either group.. The results of this pilot study suggest that ketamine, at a dose of 0.5 mg/kg, given just before ECT, did not enhance the antidepressant effect of ECT. Interestingly, the results further suggest that the coadministration of ketamine with a barbiturate anesthetic and ECT may attenuate the immediate antidepressant effects of the N-methyl-D-aspartate antagonist.

Topics: Adolescent; Adult; Aged; Anesthesia; Anesthetics, Dissociative; Antidepressive Agents; Bipolar Disorder; Combined Modality Therapy; Depression; Depressive Disorder, Major; Electroconvulsive Therapy; Electroencephalography; Female; Humans; Hypnotics and Sedatives; Ketamine; Male; Middle Aged; Psychiatric Status Rating Scales; Seizures; Thiopental; Treatment Outcome; Young Adult

Preliminary evidence suggests that the use of ketamine during electroconvulsive therapy (ECT) may be neuroprotective against cognitive impairment and have synergistic antidepressant effects. This study tested whether the addition of ketamine reduced cognitive impairment and enhanced efficacy over a course of ECT, in a randomised, placebo-controlled, double-blind study.. Fifty-one depressed patients treated with ultrabrief pulse-width right unilateral ECT were randomised to receive either ketamine (0.5mg/kg) or placebo (saline) in addition to thiopentone during anaesthesia for ECT. Neuropsychological outcomes (measured before ECT, after six treatments, and after the final ECT treatment) and mood outcomes (measured before ECT, and weekly after every three ECT treatments) were measured by a rater blinded to treatment condition.. Neuropsychological outcomes did not differ between groups. The ECT-ketamine group had a slightly greater improvement in depressive symptoms over the first week of treatment and at one-week follow up, though there was no overall difference in efficacy at the end of the ECT course. No psychomimetic effects were detected.. The study was conducted in a clinical setting, so not all aspects of ECT treatment were fully controlled. Thiopentone doses differed slightly between groups, in order to accommodate the addition of ketamine to the anaesthetic.. The addition of ketamine did not decrease cognitive impairment in patients having ultrabrief pulse-width right unilateral ECT, but was safe and slightly improved efficacy in the first week of treatment and at one-week follow up.. Clinicaltrials.gov ID: NCT00680433. Ketamine as an anaesthetic agent in electroconvulsive therapy (ECT). www.clinicaltrials.gov.

Topics: Adult; Affect; Bipolar Disorder; Cognition; Cognition Disorders; Depressive Disorder, Major; Double-Blind Method; Electroconvulsive Therapy; Electroencephalography; Female; Follow-Up Studies; Humans; Ketamine; Male; Middle Aged; Mood Disorders; Neuroprotective Agents; Neuropsychological Tests; Thiopental; Treatment Outcome

Topics: Adult; Age Factors; Anxiety Disorders; Arousal; Bipolar Disorder; Central Nervous System; Depression; Depressive Disorder, Major; Female; Galvanic Skin Response; Humans; Injections, Intravenous; Insulin; Male; Methamphetamine; Middle Aged; Placebos; Psychotic Disorders; Sex Factors; Sleep; Sodium; Thiopental

This study compares the data of (modified) electroconvulsive theraphy (ECT) applications from two different inpatient clinics in Turkey: Kocaeli Derince Training and Research Hospital (Clinic-I) and Kocaeli University (Clinic-II).. Recorded files of patients from the two clinics were compared in terms of ECT indications, number and duration of seizures, and anesthetic agents used (propofol vs. thiopental). ECT applications occurring between January 2011 and January 2013 were included in the study.. A total of 86 patients (9.5% of the inpatients) received ECT in Clinic-I and 103 patients (21.1% of the inpatients) in Clinic-II during the period studied. The yearly ECT rate (treated person rate per 10,000 per year) was 0.59/10,000 for Kocaeli (Turkey) as a whole. The overall number of ECT applications was 539 in Clinic-I and 999 in Clinic-II, and the average number of ECT sessions for each patient was 6.4 ± 2.33 in Clinic-I and 9.69 ± 4.66 in Clinic-II. The majority of indications were depressive disorders and insufficient response to medicine. Patients in the clinic which utilized thiopental as the anesthetic agent experienced more cardiovascular and respiratory side effects than the one which used propofol. The number of ECT sessions required was greater for patients with schizoaffective disorder than for others.. The administration of ECT was considered to be a reliable method of treatment in these clinics. With respect to specific anesthetic agents, propofol was found to have less hemodynamic side effects and shorter seizure durations than thiopental.

Topics: Adult; Anesthesia, General; Anesthesia, Intravenous; Anesthetics, Intravenous; Bipolar Disorder; Bradycardia; Depressive Disorder; Electroconvulsive Therapy; Female; Hemodynamics; Hospital Units; Humans; Male; Medical Records; Propofol; Retrospective Studies; Schizophrenia; Seizures; Thiopental; Time Factors; Treatment Outcome; Turkey

There is increasing evidence that a greater degree of postictal suppression (the abruptness and magnitude of the EEG voltage drop at the end of the seizure) may be associated with better clinical response to electroconvulsive therapy. Retrospective studies have shown better postictal suppression when propofol is used for induction rather than the more commonly used methohexital. We report two patients in whom poor postictal suppression was rectified by switching from methohexital to propofol. The clinical significance of this improvement in postictal suppression is unclear, and prospective studies will be needed to clarify any clinical benefits.

Topics: Anesthesia, Intravenous; Anesthetics, Intravenous; Bipolar Disorder; Depressive Disorder, Major; Electroconvulsive Therapy; Female; Humans; Methohexital; Middle Aged; Propofol; Seizures; Thiopental; Treatment Outcome

Electro-convulsive (ECT) therapy is frequently the treatment of choice in pregnant patients. It has been reported that administration of ECT in pregnancy is safe and effective. However, there are few controlled studies of the effects of ECT on pregnancy. The literature is not conclusive regarding ECT-related complications in pregnancy. We describe here the case of a primigravida with bipolar disorder who underwent nine sessions of ECT during pregnancy. The patient experienced vaginal bleeding after each session of ECT. Thiopental and succinylcholine were administered as an anesthetic (4 mg/kg thiopental) and muscle relaxant (1 mg/kg succinylcholine), respectively. ECT was discontinued and re-challenged after 20 days. The patient experienced bleeding after ECT again. Our case is somewhat unique because it demonstrates the potential maternal problem of vaginal bleeding as a result of ECT. In our case ECT led to vaginal bleeding and the bleeding stopped when ECT was ceased. Re-challenge was conducted. Although the safety of ECT administration in pregnancy has been discussed in many previous reports, its safety should be studied further.

Topics: Adult; Anesthetics, Intravenous; Bipolar Disorder; Electroconvulsive Therapy; Female; Gravidity; Humans; Pregnancy; Pregnancy Complications; Succinylcholine; Thiopental; Uterine Hemorrhage

We describe a case of catatonia in a 51-year-old man in whom the catatonic symptoms could not be distinguished from symptoms of frontotemporal dementia (FTD) until they were resolved with electroconvulsive therapy (ECT). When it is difficult to distinguish between catatonia and FTD in patients with frontal dysfunction associated with frontal lobe atrophy, we believe that sequential administration of benzodiazepines and ECT is important for therapeutic diagnosis because the risk of missing a diagnosis of catatonia outweighs the risks associated with administration of benzodiazepines and/or ECT.

Topics: Anti-Arrhythmia Agents; Anticonvulsants; Antimanic Agents; Atrophy; Atropine; Bipolar Disorder; Catatonia; Diagnosis, Differential; Electroconvulsive Therapy; Follow-Up Studies; Frontal Lobe; Frontotemporal Dementia; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neuromuscular Depolarizing Agents; Succinylcholine; Thiopental; Treatment Outcome; Valproic Acid

Topics: Adult; Antipsychotic Agents; Bipolar Disorder; Electroconvulsive Therapy; Humans; Male; Malignant Hyperthermia; Neuroleptic Malignant Syndrome; Pancuronium; Thiopental

During EST of schizophrenic (with a prevalent depressive symptomatology) and manic-depressive patients refractory to medicinal therapy, it was possible to find the following conditions. There was a definite advantage in the use of a narcotizing preparation such as epontal with a relaxant listenon compared to a tiopenthal narcosis. This may be due to a short-time narcotic effect of epontal, the absence of postnarcotic symptoms such as expressed apathy, weakness, headaches, which can be observed during 2-3 hours, following tiopenthal narcosis.

Topics: Adult; Anesthesia, General; Bipolar Disorder; Electroconvulsive Therapy; Female; Humans; Male; Middle Aged; Propanidid; Schizophrenia; Succinylcholine; Thiopental

Topics: Anesthesia, General; Benperidol; Bipolar Disorder; Body Weight; Electroconvulsive Therapy; Female; Humans; Male; Methohexital; Preanesthetic Medication; Propanidid; Schizophrenia; Thiopental; Time Factors

Topics: Anesthesia; Anesthesiology; Barbital; Barbiturates; Bipolar Disorder; General Surgery; Humans; Mental Disorders; Postoperative Complications; Postoperative Period; Thiopental