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The effect of anaesthetic dose on response and remission in electroconvulsive therapy for major depressive disorder: nationwide register-based cohort study
Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden.
Örebro University, School of Medical Sciences.ORCID iD: 0000-0001-7454-3065
Department of Anaesthesiology, Surgical Services and Intensive Care, Karolinska University Hospital, Sweden; and Department of Physiology and Pharmacology, Karolinska Institutet, Sweden.
Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden.
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2021 (English)In: BJPsych Open, E-ISSN 2056-4724, Vol. 7, no 2, article id e71Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Electroconvulsive therapy (ECT) is a safe and effective treatment for major depressive disorder (MDD). ECT treatment effect relies on induced generalised seizures. Most anaesthetics raise the seizure threshold and shorten seizure duration. There are no conclusive studies on the effect of anaesthetic dose on response and remission rates with ECT for MDD.

AIMS: We aimed to examine the effect of different dose intervals of anaesthetics on response and remission after ECT for MDD.

METHOD: We conducted a nationwide cohort study, using data from Swedish registers. Low-, medium- and high-dose intervals, adjusted for age and gender, were constructed for each anaesthetic drug. Response and remission were measured with the Clinical Global Impression - Severity and Improvement scales (CGI-I and CGI-S), and a self-rated version of the Montgomery-Åsberg Depression Rating Scale (MADRS-S). Logistic regression models were used to calculate adjusted odds ratios for response and remission rates.

RESULTS: The study included 7917 patients who received ECT for MDD during 2012-2018. Patients were given either thiopental (64.1%) or propofol (35.9%). Low-dose intervals of anaesthetics were associated with increased rates of response (CGI-I: odds ratio 1.22, 95% CI 1.07-1.40, P = 0.004; MADRS-S: odds ratio 1.31, 95% CI 1.09-1.56, P = 0.004) and remission (CGI-S: odds ratio 1.37, 95% CI 1.17-1.60, P ≤ 0.001; MADRS-S: odds ratio 1.31, 95% CI 1.10-1.54, P = 0.002).

CONCLUSIONS: We found improved treatment outcomes with low- compared with high-dose anaesthetic during ECT for MDD. To enhance treatment effect, deep anaesthesia during ECT for MDD should be avoided.

Place, publisher, year, edition, pages
Royal College of Psychiatrists , 2021. Vol. 7, no 2, article id e71
Keywords [en]
Depressive disorders, antidepressants, electroconvulsive therapy, epidemiology, outcome studies
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:oru:diva-90689DOI: 10.1192/bjo.2021.31ISI: 000631422500001PubMedID: 33752777Scopus ID: 2-s2.0-85108204439OAI: oai:DiVA.org:oru-90689DiVA, id: diva2:1539439
Funder
Stiftelsen Söderström - Königska sjukhemmet
Note

Funding Agency:

Stiftelsen Professor Bror Gadelius Minnesfond  

Available from: 2021-03-24 Created: 2021-03-24 Last updated: 2023-12-08Bibliographically approved

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Nordenskjöld, Axel

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