A Randomized Pilot Study Comparing Ketamine and Methohexital Anesthesia for Electroconvulsive Therapy in Patients With Depression.

OBJECTIVE: This randomized controlled pilot study examines the differences in response to electroconvulsive therapy (ECT) as defined by an improvement of depressive symptoms between ketamine and methohexital as the primary anesthetic agent. Adverse effects and cognitive tolerability were also examined. METHODS: Subjects undergoing ECT for unipolar or bipolar depression were randomized to receive ketamine or methohexital as the anesthetic agent. Primary outcome measure includes the Hamilton rating scale for depression (17-item). Secondary outcome measures included the mini-mental status examination and Beck depression inventory. All ratings were conducted masked to anesthetic agent. Because of multiple outcome measures obtained over time, mixed models were used to account for the correlations among the measurements within the subjects. Because outcomes were either normally distributed or approximately normally distributed, general linear mixed models were fit with a random intercept specified. RESULTS: A total of 21 subjects were enrolled, and 16 were randomized (methohexital, n = 8; ketamine, n = 8). The 2 treatment groups did not differ statistically in any demographic characteristic. No statistical difference was found between the ketamine and methohexital groups for an improvement in depressive symptoms (P = 0.6); however, subjects in both groups showed significant improvement in depression over time (ketamine, P < 0.0001; methohexital, P < 0.0001). Mini-mental status examination results did not differ between groups, and fatigue was reported more in subjects receiving ketamine (P = 0.03). CONCLUSIONS: The results of this pilot study are inconclusive because they lack power to support an advantage of ketamine anesthesia compared with methohexital in ameliorating depressive symptoms for electroconvulsive therapy.

Pregnancy and Electroconvulsive Therapy: A Multidisciplinary Approach.

OBJECTIVE: To scrutinize a series of pregnant women treated with electroconvulsive therapy (ECT) at a tertiary treatment center and combine these data with a literature review to refine the treatment guidelines for ECT during pregnancy. METHODS: A retrospective chart review of mentally ill pregnant patients treated with ECT since the establishment of a formal women's mental health program. RESULTS: A total of 8 pregnant women treated with ECT were identified from January 2012 to August 2014. Information was extracted from the medical records of a total of 30 ECT treatments across this group. Subjects received an average of 3.75 ECT treatments (range, 1-7). All women were diagnosed as having a mood disorder (either unipolar or bipolar), and 5 of the 8 women had suicidal ideation. The treatment team for ECT was consistent across all treatments. Two women experienced significant complications after the initial treatment: 1) an acute episode of complete heart block; and 2) acute onset of mania after ECT. Obstetrical complications included 2 women with preterm delivery-one secondary to premature rupture of membranes. No other complications or adverse outcomes were recorded. The 5 women with suicidal ideation had symptom resolution, and significant symptom improvement was noted in 6 of the 8 women. CONCLUSIONS: Electroconvulsive therapy is a safe and effective treatment during pregnancy and of particular benefit in the acute treatment of suicidal ideation.

Association between C-reactive protein and suicidal behavior in an adult inpatient population.

OBJECTIVES: To examine the relationship of inflammation and suicidal behavior in hospitalized adult psychiatric patients. METHOD: We retrospectively examined serum high sensitivity C-reactive protein (hsCRP) levels in inpatients at a tertiary-level university hospital (N = 184). The inpatients comprised three cohorts: 1) patients admitted following a suicide attempt, 2) patients with suicidal ideation, and 3) inpatient psychiatric controls. Additionally, we gathered demographic data, clinical data, smoking status, white blood cell count, and fasting lipid panel. RESULTS: As CRP level increased, the probability of patients belonging to the suicide attempt group increased as compared to both the probabilities of being in inpatient psychiatric control and or suicide ideation groups [OR = 2.09, CI = (1.29, 3.38) and OR = 1.75, CI = (1.15, 2.66) respectively]. We also observed a significant effect of depression in that depressed patients were more likely to have a suicide attempt when compared to patients with no depression or with mania [OR = 10.38, CI = (1.97, 54.70)]. CONCLUSIONS: There seems to be an inflammation gradient, measured by CRP levels, from recent suicide attempters, suicidal ideators and psychiatric controls. We replicated the association between a pro-inflammatory state and suicidal behavior in a sample of "real world" severely ill psychiatric inpatients.