thiopental and Depressive-Disorder--Major

Recently, ketamine has attracted attention for induction of anesthesia during electroconvulsive therapy (ECT). This study compared the effects of thiopental and ketamine in patients undergoing this procedure.. This randomized, double-blind clinical trial included inpatients, with major depressive disorder, undergoing ECT. Subjects were randomly allocated to receive either ketamine or thiopental. Mini-Mental State Examination and Hamilton Depression Rating Scale were used to assess memory and depression, respectively, before the first and second ECT sessions as well as a few days and 1 month after the sixth session. The electrical charge, seizure duration, blood pressure, and heart rate were also recorded.. Of the 31 patients, 17 met the criteria for the ketamine group but 2 dropped out of the study. Therefore, 15 patients received ketamine and 14 received thiopental. Each patient underwent 6 ECT sessions. At the end of the study, depression improved significantly in both groups. However, a significant difference in depression improvement was noted only before the second ECT with ketamine compared with thiopental. Despite a significant decline in Mini-Mental State Examination scores in both groups after the first ECT, cognitive function improved afterward but was only significant in ketamine group. Seizure duration was found to be significantly longer with ketamine. Stimulus intensity used for each ECT increased gradually and linearly with a greater increase observed in thiopental group.. Ketamine administration during ECT is well tolerated and patients may experience earlier improvement in depressive symptoms, longer seizure duration, and better cognitive performance when compared with thiopental.

Topics: Adult; Analysis of Variance; Anesthesia; Anesthetics, Dissociative; Cognition; Depressive Disorder, Major; Double-Blind Method; Electroconvulsive Therapy; Female; Hemodynamics; Humans; Hypnotics and Sedatives; Ketamine; Male; Middle Aged; Neuropsychological Tests; Psychiatric Status Rating Scales; Recovery of Function; Seizures; Thiopental; Young Adult

To compare propofol and sodium thiopental as anesthetic agents for electroconvulsive therapy (ECT) in major depression with respect to clinical effect.. Participants were composed of 96 patients with depression who were administered either propofol or sodium thiopental as an anesthetic agent for bilateral ECT. The Hamilton Depression Rating Scale was administered at baseline and after 6 treatments. Algorithm-based charge dosing was used.. There was a statistically significant difference between the groups regarding postintervention Hamilton Depression Rating Scale score. The preintervention mean (SD) scores in the propofol group and the sodium thiopental group were 37.3 (2.2) and 36.7 (1.2), respectively. The postintervention mean (SD) scores in the propofol group and the sodium thiopental group were 10.7 (1.8) and 13.4 (3.3), respectively. No correlation was found between clinical response and age, weight, and body mass index. There was no association between the groups' seizure time and duration of recovery.. In conclusion, propofol may improve major depressive disorder more than sodium thiopental in patients who are receiving ECT.

Topics: Adult; Age Factors; Algorithms; Body Mass Index; Depressive Disorder, Major; Diagnostic and Statistical Manual of Mental Disorders; Double-Blind Method; Electroconvulsive Therapy; Female; Humans; Hypnotics and Sedatives; Male; Propofol; Psychiatric Status Rating Scales; Seizures; Sex Characteristics; Socioeconomic Factors; Thiopental

Although the therapeutic effect of electroconvulsive therapy (ECT) on major depressive disorder is widely investigated, there is a gap in literature regarding the possible effects of the medications used for induction of anesthesia in ECT. To the best of the authors' knowledge, this study is the first randomized double-blind clinical trial comparing the effect of etomidate and sodium thiopental on the depression symptoms in patients who have received ECT.. The participants of this study are 60 adult patients with major depressive disorder who were referred for ECT. They were randomly allocated into 1 of the 2 groups. One group received etomidate, and the other group received sodium thiopental, as medication for induction of anesthesia. All the patients received bilateral ECT. The outcomes measures included the Beck Depression Inventory score, seizure duration, and recovery duration after induction of anesthesia.. The sex ratio and mean age were not different between the 2 groups. Linear regression analysis showed that etomidate decreased the depression score more than did sodium thiopental. Seizure duration in all of the sessions in the etomidate group was significantly higher than that of sodium thiopental group.. In conclusion, etomidate may improve major depressive disorder more than sodium thiopental in patients who are receiving ECT.

Topics: Adult; Anesthesia, Intravenous; Anesthetics, Intravenous; Depressive Disorder, Major; Double-Blind Method; Electrocardiography; Electroconvulsive Therapy; Etomidate; Female; Humans; Linear Models; Male; Psychiatric Status Rating Scales; Thiopental; Treatment Outcome

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

Cardiovascular alterations during electroconvulsive therapy (ECT) are a major concern for this treatment. Although several studies have been performed to compare the effects of anesthetics on these alterations, the results are mixed and doubt still exists regarding the choice of the best drug. We conducted a randomized, double-blind clinical trial to compare the effects of 3 anesthetics used in ECT: etomidate, propofol, and thiopental. Patients (N=30) were randomized to receive one of these drugs as the anesthetic for the ECT procedure. Cardiovascular evaluation consisted of the measurement of blood systolic and diastolic pressure and heart rate before and immediately after the end of the seizure for each patient during a course of ECT. The results showed that etomidate, propofol, and thiopental were associated with similar cardiovascular effects.

Topics: Adult; Anesthesia, Intravenous; Anesthetics, Intravenous; Cardiovascular System; Depressive Disorder, Major; Dose-Response Relationship, Drug; Double-Blind Method; Electroconvulsive Therapy; Etomidate; Female; Humans; Logistic Models; Male; Middle Aged; Propofol; 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

Postictal agitation (PIA) with possible severe implications occurs in approximately 10% of electroconvulsive therapy (ECT) sessions. The pathomechanism is not well understood, and suggested treatments are empirical based. We report a case of repetitive (47/57 sessions [83%]) severe PIA after ECT in a case with severe depression. If the minimal bispectrum EEG index (BIS) value, meaning the deepest level of sedation of the thiopental narcosis dropped below 50, PIA occurred in only 9.1%. Bispectral index (BIS) monitoring made prediction and prevention of PIA possible to some degree. Postictal agitation might occur in vulnerable patients when initial depth of anesthesia is too light.

Topics: Aged; Anesthesia; Anesthetics, Dissociative; Consciousness Monitors; Depressive Disorder, Major; Electroconvulsive Therapy; Electroencephalography; Etomidate; Female; Humans; Hypnotics and Sedatives; Ketamine; Psychomotor Agitation; Thiopental

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

In a retrospective chart review, we examined the effects of ketamine, an N-methyl-d-aspartate (NMDA) receptor antagonist, as electroconvulsive therapy (ECT) anaesthetic in patients suffering from therapy-resistant depression. We included 42 patients who received ECT treatment with either ketamine (n = 16) or the barbiturate thiopental (n = 26). We analysed the number of sessions until completion of ECT treatment (used as a surrogate parameter for outcome), psychopathology as assessed by pre- and post-ECT Mini-Mental State Examination (MMSE) and Hamilton Rating Scale for Depression (HAM-D) scores as well as ECT and seizure parameters (stimulation dose, seizure duration and concordance, urapidil dosage for post-seizure blood pressure management). The ketamine group needed significantly fewer ECT sessions and had significantly lower HAM-D and higher MMSE scores afterwards. As expected, the ketamine group needed more urapidil for blood pressure control. Taking into account the limits inherent in a retrospective study design and the rather small sample size, our results nonetheless point towards synergistic effects of ECT and ketamine anaesthesia, less cognitive side effects and good tolerability of ketamine.

Topics: Aged; Anesthetics, Dissociative; Anesthetics, Intravenous; Antihypertensive Agents; Cognition Disorders; Depressive Disorder, Major; Depressive Disorder, Treatment-Resistant; Electroconvulsive Therapy; Electroencephalography; Female; Humans; Inpatients; Ketamine; Male; Middle Aged; Neuropsychological Tests; Piperazines; Psychiatric Status Rating Scales; Retrospective Studies; Thiopental; Treatment Outcome

Electroconvulsive therapy (ECT) is performed under anesthesia and muscle relaxation. Only well-generalized seizures seem to have the high "adequacy" or "quality" that have been claimed to reflect positive predictive power for the outcome of an ECT course. The induction of well-generalized seizures can be potentially influenced by several variables. One major variable is concurrent medication including anesthetic drugs, since most anesthetic drugs are potent anticonvulsives. We hypothesized a negative influence of anesthetics and benzodiazepines but a positive effect of antidepressants and antipsychotics concurrently applied during ECT on seizure adequacy.. We included inpatients (n = 41) with a DSM-IV-diagnosed major depressive episode treated with ECT (411 ECT sessions) during a period of 20 months (May 2005 to December 2006) in an open label and noncontrolled study. A repeated measurement regression analysis was performed with 8 seizure adequacy parameters as dependent variables. We indirectly quantified narcotic agent influence with bispectral index monitoring.. In contrast to the impact of psychiatric comedication, this measure of "depth of narcosis" prior stimulation turned out to influence most seizure adequacy parameters in a highly significant manner.. Thus, we concluded that the anticonvulsive properties of narcotic agents have much higher influence than concomitant psychotropic medication. Our data support the view that a significant influence of concurrent psychotropic drugs on seizure adequacy markers is missing, especially when directly compared with other confounders like stimulation energy, age, and depth of narcosis. The latter suggests to further prove the idea that lighter anesthesia is indeed an important tool to get patients faster into remission.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anesthesia, General; Anesthetics, Intravenous; Antidepressive Agents; Antipsychotic Agents; Combined Modality Therapy; Depressive Disorder, Major; Electroconvulsive Therapy; Electroencephalography; Female; Humans; Male; Middle Aged; Psychotropic Drugs; Reaction Time; Seizures; Stupor; Thiopental; Treatment Outcome

Topics: Aged; Anesthesia; Anesthetics, Intravenous; Cognition Disorders; Depressive Disorder, Major; Electroconvulsive Therapy; Etomidate; Female; Humans; Long-Term Care; Neuropsychological Tests; Thiopental

Many factors influence seizure duration associated with electroconvulsive therapy (ECT). This is a chart review study to assess seizure duration measured with both electroencephalography and electromyography after anesthetic induction with either thiopentone or etomidate. Thirty-seven patients receiving ECT for depression were entered into the study, and a pair of seizures was measured from each patient. Alternate induction agents were used in sequential pairings, and the study was controlled for interval between seizures, laterality, and percent energy. Etomidate was associated with a significantly (p = 0.0002, F = 15.84, df = 1, analysis of variance) longer seizure duration (mean = 34.43 s, SD = 16.06) than thiopentone (mean = 21.73 s, SD = 9.33).

Topics: Adolescent; Adult; Aged; Anesthesia; Anesthetics, Intravenous; Depressive Disorder, Major; Electroconvulsive Therapy; Etomidate; Female; Humans; Male; Mental Disorders; Middle Aged; Reaction Time; Thiopental

Topics: Depression; Depressive Disorder; Depressive Disorder, Major; Electroencephalography; Humans; Psychotic Disorders; Reproducibility of Results; Thiopental