Randomized controlled trial of the effect of anesthetic dose during electroconvulsive therapy for major depression

Electroconvulsive therapy (ECT) is an effective treatment for major depressive disorder (MDD). The antidepressive effect of ECT relies on an induced generalized seizure. ECT is given under general anesthesia, even though most anesthetic drugs increase the seizure threshold. This could diminish the therapeutic effect of ECT.

No trial has addressed the impact of anesthetic dose on treatment outcome with ECT for MDD.

In this pilot for a randomized controlled, double blind, clinical trial 30 hospitalized patients with MDD for which ECT is indicated are randomized 1:1 to anesthesia with either a low or high dose thiopental during ECT.

A blinded rater asesses severity of depressive symptoms with Montgomery-Åsberg Depression Rating Scale (MADRS) and subjective cognitive dysfunctions before ECT and after six ECTs.

After this, patients are given treatment as usual and are followed with register data up till one year after ECT, to compare the lengths of the ECT series, memory function six months after ECT, and risk of MDD relapse in the low versus high thiopental dose group. Patients will be recruited 2024-2025.

Based on the pilor study data we will plan for a national RCT.

The main purpose of the study is to test if ECT reduces MADRS scores more effectively with a low thiopental dose compared to a high thiopental dose for anesthesia.

Optimized treatment effect of ECT has great clinical value, with more rapid alleviation of severe depression and reduced length of hospital stay.