The effect of anaesthetic dose on response and remission in electroconvulsive therapy for major depressive disorder: nationwide register-based cohort study
Autor: | Max Bell, Ridwanul Amin, Alexander Kronsell, Mikael Tiger, Axel Nordenskjöld, Ellenor Mittendorfer-Rutz |
---|---|
Rok vydání: | 2021 |
Předmět: |
medicine.medical_specialty
Depressive disorders medicine.medical_treatment Logistic regression behavioral disciplines and activities electroconvulsive therapy 03 medical and health sciences 0302 clinical medicine Electroconvulsive therapy Internal medicine mental disorders medicine Seizure threshold business.industry outcome studies Odds ratio medicine.disease General Adult 030227 psychiatry Psychiatry and Mental health antidepressants Papers Clinical Global Impression Major depressive disorder epidemiology business Propofol 030217 neurology & neurosurgery Cohort study medicine.drug |
Zdroj: | BJPsych Open |
ISSN: | 2056-4724 |
Popis: | 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. |
Databáze: | OpenAIRE |
Externí odkaz: |