Clinical TrialTreatment-Resistant Depression (TRD)KetamineKetamineCompleted

Cognitive Recovery After Electroconvulsive Therapy and General Anesthesia

Single-blinded, randomised, crossover trial (n=17) in treatment-resistant depression comparing etomidate- vs ketamine-general anaesthesia with ECT and ketamine alone; ketamine ~2 mg/kg IV across six treatment sessions per participant.

Target Enrollment
17 participants
Study Type
Phase NA interventional
Design
Randomized, single Blind

Detailed Description

This study characterises recovery of brain activity and cognitive function following electroconvulsive therapy (ECT) and general anaesthesia using ketamine or etomidate in patients with treatment-resistant depression.

Design: single-blinded, randomised crossover. After a titration ECT session with etomidate, participants undergo six treatment sessions (three per week for two weeks) comprising etomidate+ECT, ketamine+ECT, and ketamine alone in randomized order; ketamine dosing is ~2 mg/kg.

Outcomes include cognitive assessments and EEG measures of recovery after seizure and anaesthesia to compare cognitive reconstitution and electrophysiological patterns across anaesthetic strategies.

Study Protocol

Preparation

sessions

Dosing

6 sessions

Integration

sessions

Study Arms & Interventions

Etomidate + ECT

active comparator

General anaesthesia induced with etomidate (~0.2 mg/kg) followed by ECT at therapeutic charge.

Interventions

  • Compound
    via Other• per session

    Etomidate general anaesthesia ~0.2 mg/kg; ECT charge determined at titration (procedure: ECT).

  • Compound
    via Other• per session

    Procedure: Electroconvulsive Therapy; charge determined during titration.

Ketamine + ECT

experimental

General anaesthesia induced with ketamine (~2 mg/kg) followed by ECT at therapeutic charge.

Interventions

  • Ketamine2 mg/kg
    via IV• per session

    Ketamine general anaesthesia ~2 mg/kg (1–2.5 mg/kg range described).

  • Compound
    via Other• per session

    Procedure: Electroconvulsive Therapy; charge determined during titration.

Ketamine alone

active comparator

Ketamine general anaesthesia without subsequent ECT charge (sham comparator).

Interventions

  • Ketamine2 mg/kg
    via IV• per session

    Ketamine general anaesthesia ~2 mg/kg; no ECT charge administered.

Participants

Ages
18 – 60
Sexes
Male & Female

Inclusion Criteria

  • Inclusion Criteria:
  • Treatment resistant depression requiring outpatient ECT
  • Planned right unilateral ECT stimulation
  • English speaking
  • Able to provide written informed consent

Exclusion Criteria

  • Exclusion Criteria:
  • Known brain lesion or neurological illness that causes cognitive impairment
  • Schizophrenia
  • Schizoaffective disorder
  • Blindness or deafness or motor impediments that may impair performance for cognitive testing battery
  • Inadequate ECT seizure duration with etomidate

Study Details

Locations

Washington University School of Medicine — St Louis, Missouri, United States

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