Electroconvulsive therapy pre-treatment with low dose propofol: Comparison with unmodified treatment

Adarsh Tripathi, Nathan C. Winek, Kapil Goel, Douglas D'Agati, Jesus Gallegos, Geetha Jayaram, Thai Nguyen, Punit Vaidya, Peter Zandi, Jitendra K. Trivedi, Irving M. Reti

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Whilst electroconvulsive therapy (ECT) is routinely administered under anesthesia in developed nations, in many developing countries, ECT is still administered unmodified. This practice has attracted considerable scrutiny with calls to ban unmodified ECT. However, there are no affordable alternatives for many poor, acutely ill psychiatric patients. We evaluated whether administration of intravenous propofol 0.5 mg/kg for sedation by the ECT psychiatrist just prior to otherwise unmodified treatment improved acceptance of and reduced anxiety surrounding the treatment. Method: We conducted an open label trial at The King George's Medical University in Lucknow, India. Forty-nine patients received propofol pre-treatment and 50 patients received unmodified treatment as usual. Results: Socio-demographic profiles, diagnoses and clinical responses were comparable. Patients who received propofol experienced less anxiety monitored by the State-Trait Anxiety Inventory just prior to ECT (p < 0.001), and had a more favorable attitude towards treatment assessed by an established questionnaire (Freeman and Kendell, 1980). Propofol patients were less likely to experience post-ictal delirium monitored by the CAM-ICU (p = 0.015) and had fewer cognitive side-effects on the MMSE (p = 0.004). There were no adverse events associated with propofol administration. Conclusion: Whilst unmodified ECT should never be used when modified ECT under anesthesia is available, we have found low dose propofol can be safely administered by the ECT psychiatrist to sedate patients pre-treatment who would otherwise receive completely unmodified treatment. The intervention was associated with reduced anxiety and a more positive attitude towards ECT, without compromising efficacy. A randomized double blind controlled study is necessary to confirm these benefits.

Original languageEnglish (US)
Pages (from-to)173-179
Number of pages7
JournalJournal of Psychiatric Research
Volume53
Issue number1
DOIs
StatePublished - 2014

Keywords

  • Anxiety
  • Electroconvulsive therapy
  • Modified
  • Propofol
  • Sedating
  • Unmodified

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry

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