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Different regimens of intravenous sedatives or hypnotics for electroconvulsive therapy (ECT) in adult patients with depression


Lihua, P. et al

Subject Keywords: Intravenous sedative, Hypnotics, Anti-depression, Seizure, ECT.
Set: Mental Health
Type: Article
Region: International (other)

Depression is a common mental disorder. It can present as loss of interest or pleasure, sadness, disturbed sleep or appetite, feelings of guilt or low self worth. In 2008, the World Health Organization (WHO) estimated that depression was the second leading cause of disability-adjusted life-years among all men and women between 15 and 44 years of age. The treatment of choice for severe and recurrent depression is electroconvulsive therapy (ECT). ECT involves the application of an electrical current to the patient's head. The aim is to induce a controlled convulsion. Patients usually undergo several sessions of ECT.

To minimize adverse events and improve the quality of ECT, patients receive anaesthetic agents such as intravenous sedatives or hypnotics. These agents can influence the effectiveness of ECT but can cause potential adverse effects. It would be helpful to identify which is the best anaesthetic agent for ECT in this group of patients.

This Cochrane review examined whether different types of anaesthetic agents could have an effect on anti-depression therapy and reported on the safety of those agents. The evidence is current to December 2012. We included in this review 18 randomized controlled trials (599 participants). We analysed nine pairs of comparisons: methohexital versus propofol; thiopental versus propofol; etomidate versus propofol; thiopental versus etomidate; etomidate versus methohexital; methohexital versus midazolam; thiopental versus midazolam; midazolam versus propofol; and thiamylal versus propofol.

Our analysis revealed no difference in the reduction of depression scores when methohexital was compared with propofol. Propofol reduced seizure duration to a greater extent than methohexital. No difference in seizure duration was noted when thiopental was compared with propofol. Patients recovered faster from anaesthesia when propofol rather than thiopental was used. Adverse events related to anaesthesia induction agents and to the treatment for depression were not well reported in most trials. We found the quality of the evidence to be low. Larger well-designed randomized controlled trials are needed. More clinically relevant outcomes (such as remission of depressive symptoms and postanaesthetic adverse events) during a longer follow-up period should be reported in future studies.



Rights: © The Cochrane Collaboration
Suggested citation:

Lihua, P. et al. (2014) Different regimens of intravenous sedatives or hypnotics for electroconvulsive therapy (ECT) in adult patients with depression [Online]. Available from: [Accessed: 19th August 2018].


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