The choice of anesthetics and the effect on the Hamilton depression rating scale in therapy resistant depression

Abstract

Introduction

The Dutch guideline ECT does not favor any anesthetic drug during electroconvulsive therapy. Although there are differences in seizure duration which may influence the effect of ECT, ethomidate, methohexital and propofol are “equal”. The influence of switching anesthetics during ECT is unknown. The reason for switching anesthetics is insufficient improvement in depressive symptomatology which is based on clinical picture. The Hamilton is a multiple item questionnaire which can give an indication of depression and which can evaluate recovery.

Objectives

Does the choice of anesthetics or switching anesthetics influence the effect of ECT on the Hamilton depression rating scale?

Aims

To determine whether the choice of anesthetic drugs in the case of switching influences the effect on the Hamilton depression rating scale.

Methods

We collected data of patients who received ECT for therapy resistant depression over the past five years. Choice of anesthetics, eventually switch and the score on the HDRS before and after ECT were included. The data was statistical analyzed.

Results

50 patients received ECT during past 5 years. ECT gives an improvement on the HDRS in all cases, whether there was a switch or not. Switching from methohexital to ethomidate when shock duration is less than 21 seconds gives a significant difference in improvement on the HDRS (BI 1.288 to 13.538) compared to patients who did not switch.

Conclusions

There are no significant differences on HDRS effect between the different anesthetics. Switching from methohexital to ethomidate gives a significant improvement on HDRS compared with no switch.

Disclosure of interest

The authors have not supplied their declaration of competing interest.