Prevalence and Correlates of Likely Major Depressive Disorder among Medical Students in Alberta, Canada.

BACKGROUND: Medical students are exposed to multiple factors during their academic and clinical studies that contribute to depression. AIMS: This study aims to examine the prevalence and correlates of likely major depressive disorder (MDD) among medical students. METHODS: This study utilized a descriptive cross-sectional design. Data were collected through a self-administered online survey, which included questions on sociodemographic characteristics and likely MDD using the PHQ-9. Data were analyzed using a descriptive, Chi-square test and logistic regression model. RESULTS: There were 246 medical students who participated in the survey. The majority were females, 155 (65.1%); Caucasian, 158 (66.4%); and in a relationship, 168 (70.5%). The prevalence of likely MDD was 29.1%. Respondents who did not feel supported and respondents who were neutral about their social support, friends, and family, were 11 and 4 times more likely to experience MDD than those who felt well supported (OR = 11.14; 95% CI: 1.14-108.80) and (OR = 4.65; 95% CI: 1.10-19.56), respectively. CONCLUSIONS: This study suggests a high prevalence of likely MDD among medical students who do not feel they have sufficient social support from friends and family. Social adjustments, including talking to friends and family and participating in leisure activities, could reduce the level of depression among medical students.

Low-dose ketamine does not improve the speed of recovery from depression in electroconvulsive therapy: a randomized controlled trial

Objective: Electroconvulsive therapy (ECT) is a well-established therapeutic intervention for major depressive disorder. Recent literature has shown that the anesthetic agent ketamine has some antidepressant properties at low doses and may be an alternative therapy for treatment-resistant major depressive disorder. We hypothesized that the use of low-dose ketamine as an anesthetic adjunct in ECT would more rapidly improve depression while maintaining hemodynamic stability than ECT with propofol alone. Methods: Institutional ethics approval was obtained, and the use of ketamine in this study was approved by Health Canada. This is a randomized, double-blinded, placebo-controlled trial that involved ketamine administration at 0.5 mg/kg IV in addition to propofol anesthesia for ECT. The primary outcome was the number of ECT treatments required to achieve a 50% reduction in the Montgomery-Asberg Depression Rating Scale (MADRS). Secondary outcomes included the number of ECT treatments required to achieve a 25% reduction in MADRS score, as well as any differences in the Clinical Global Impression Scale for Severity, hemodynamic variables, and seizure duration. Adverse events were recorded for safety assessment. Results: A total of 45 patients completed the study. No difference was found between groups with respect to the primary or secondary outcomes. The ketamine group showed a trend towards a decreased dose of propofol required to achieve adequate anesthesia. No adverse events were reported. Conclusion: Low-dose ketamine does not improve psychiatric outcomes in the setting of propofol-based anesthesia for ECT. Specifically, ketamine did not reduce the number of ECT sessions necessary to achieve a 50 or 25% reduction in MADRS scores. Reassuringly, the fact that no differences in hemodynamic variables or unexpected adverse events occurred suggests that low-dose ketamine may be safely used in this setting should clinical indications warrant its use. Clinical trial registration: ClinicalTrials.gov, NCT02579642

Low-dose ketamine does not improve the speed of recovery from depression in electroconvulsive therapy: a randomized controlled trial.

OBJECTIVE: Electroconvulsive therapy (ECT) is a well-established therapeutic intervention for major depressive disorder. Recent literature has shown that the anesthetic agent ketamine has some antidepressant properties at low doses and may be an alternative therapy for treatment-resistant major depressive disorder. We hypothesized that the use of low-dose ketamine as an anesthetic adjunct in ECT would more rapidly improve depression while maintaining hemodynamic stability than ECT with propofol alone. METHODS: Institutional ethics approval was obtained, and the use of ketamine in this study was approved by Health Canada. This is a randomized, double-blinded, placebo-controlled trial that involved ketamine administration at 0.5 mg/kg IV in addition to propofol anesthesia for ECT. The primary outcome was the number of ECT treatments required to achieve a 50% reduction in the Montgomery-Asberg Depression Rating Scale (MADRS). Secondary outcomes included the number of ECT treatments required to achieve a 25% reduction in MADRS score, as well as any differences in the Clinical Global Impression Scale for Severity, hemodynamic variables, and seizure duration. Adverse events were recorded for safety assessment. RESULTS: A total of 45 patients completed the study. No difference was found between groups with respect to the primary or secondary outcomes. The ketamine group showed a trend towards a decreased dose of propofol required to achieve adequate anesthesia. No adverse events were reported. CONCLUSION: Low-dose ketamine does not improve psychiatric outcomes in the setting of propofol-based anesthesia for ECT. Specifically, ketamine did not reduce the number of ECT sessions necessary to achieve a 50 or 25% reduction in MADRS scores. Reassuringly, the fact that no differences in hemodynamic variables or unexpected adverse events occurred suggests that low-dose ketamine may be safely used in this setting should clinical indications warrant its use. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02579642.

Reducing Burnout and Promoting Health and Wellness Among Medical Students, Residents, and Physicians in Alberta: Protocol for a Cross-Sectional Questionnaire Study.

BACKGROUND: Burnout is an increasingly common and insidious phenomenon experienced by workers in many different fields, although it is of particular concern among physicians and trainees due to the nature of their work. It is estimated that one-third of practicing physicians will experience burnout during their career, and this rate is expected to continue to increase. Burnout has significant implications, as it has been identified as a contributor to increased medical errors, decreased patient satisfaction, substance use, workforce attrition, and suicide. OBJECTIVE: This study will evaluate the prevalence and impact of burnout on physicians, residents, and medical students in Alberta. METHODS: Quantitative and qualitative data collected through self-administered, anonymous, online questionnaires will be used in this cross-sectional provincial study design. Data collection tools were developed based on published literature and questions from previously validated instruments. The tools capture relevant demographic information, mental health status, and rates of burnout, as well as factors contributing to both burnout and resilience among respondents. We anticipate a sample size of 777 medical students, 959 residents, and 1961 physicians to represent the respective ratios of trainees and practicing physicians in the province of Alberta. RESULTS: Study recruitment will begin in September 2020, with 4 weeks of data collection. The results of this study are anticipated within 12 months from the end of data collection. It is expected that the results will provide an overview of the prevalence of burnout among those training and working in medicine in Alberta, identify contributors to burnout, and help develop interventions aimed at reducing burnout. CONCLUSIONS: This study's aim is to examine burnout prevalence and contributing factors among medical trainees and physicians in Alberta. It is expected that the results will identify and examine individual and organizational practices that contribute to burnout and help develop strategies and interventions focused on mitigating burnout and its sequelae. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/16285.