scholarly journals Speed of remission in elderly patients with depression: Electroconvulsive therapy v. medication

2015 ◽  
Vol 206 (1) ◽  
pp. 67-71 ◽  
Author(s):  
Harm-Pieter Spaans ◽  
Pascal Sienaert ◽  
Filip Bouckaert ◽  
Julia F. van den Berg ◽  
Esmée Verwijk ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Electroconvulsive Therapy ◽  
Controlled Trial ◽  
Severe Depression ◽  
Madrs Score ◽  
Life Threatening ◽  
Dsm Iv ◽  
Randomised Controlled ◽  
Mean Time ◽  
Fast Acting

BackgroundSevere depression can be a life-threatening disorder, especially in elderly patients. A fast-acting treatment is crucial for this group. Electroconvulsive therapy (ECT) may work faster than medication.AimsTo compare the speed of remission using ECT v. medication in elderly in-patients.MethodThe speed of remission in in-patients with a DSM-IV diagnosis of major depression (baseline MADRS score $20) was compared between 47 participants (mean age 74.0 years, s.d. = 7.4) from an ECT randomised controlled trial (RCT) and 81 participants (mean age 72.2 years, s.d. = 7.6) from a medication RCT (nortriptyline v. venlafaxine).ResultsMean time to remission was 3.1 weeks (s.d. = 1.1) for the ECT group and 4.0 weeks (s.d. = 1.0) for the medication group; the adjusted hazard ratio for remission within 5 weeks (ECT v. medication) was 3.4 (95% CI 1.9–6.2).ConclusionsConsidering the substantially higher speed of remission, ECT deserves a more prominent position in the treatment of elderly patients with severe depression.

scholarly journals Ketamine as the anaesthetic for electroconvulsive therapy: The KANECT randomised controlled trial

2017 ◽  
Vol 210 (6) ◽  
pp. 422-428 ◽  
Author(s):  
Gordon Fernie ◽  
James Currie ◽  
Jennifer S. Perrin ◽  
Caroline A. Stewart ◽  
Virginica Anderson ◽  
...  
Keyword(s):  
Electroconvulsive Therapy ◽  
Memory Impairment ◽  
Controlled Trial ◽  
Severe Depression ◽  
Antidepressant Effect ◽  
Depression Severity ◽  
Double Blind ◽  
Parallel Design ◽  
Randomised Controlled ◽  
Intravenous Ketamine

BackgroundKetamine has recently become an agent of interest as an acute treatment for severe depression and as the anaesthetic for electroconvulsive therapy (ECT). Subanaesthetic doses result in an acute reduction in depression severity while evidence is equivocal for this antidepressant effect with anaesthetic or adjuvant doses. Recent systematic reviews call for high-quality evidence from further randomised controlled trials (RCTs).AimsTo establish if ketamine as the anaesthetic for ECT results in fewer ECT treatments, improvements in depression severity ratings and less memory impairment than the standard anaesthetic.MethodDouble-blind, parallel-design, RCT of intravenous ketamine (up to 2 mg/kg) with an active comparator, intravenous propofol (up to 2.5 mg/kg), as the anaesthetic for ECT in patients receiving ECT for major depression on an informal basis. (Trial registration: European Clinical Trials Database (EudraCT): 2011-000396-14 and clinicalTrials.gov: NCT01306760.)ResultsNo significant differences were found on any outcome measure during, at the end of or 1 month following the ECT course.ConclusionsKetamine as an anaesthetic does not enhance the efficacy of ECT.

Efficiency of Donepezil in Elderly Patients Undergoing Orthopaedic Surgery Due To Underlying Post-Operative cognitive Dysfunction: Study Protocol for A Multicentre Randomised Controlled Trial

2021 ◽  
Author(s):  
Huichen Zhu ◽  
Lu Cong ◽  
Yi Chen ◽  
Shaoyi Chen ◽  
Lingke Chen ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Elderly Patients ◽  
Cognitive Dysfunction ◽  
Orthopaedic Surgery ◽  
Controlled Trial ◽  
Acetylcholinesterase Inhibitor ◽  
Critical Role ◽  
Double Blind ◽  
Choline Acetyl Transferase ◽  
Randomised Controlled

Abstract Background Post-operative cognitive dysfunction (POCD) is an overarching term used to describe cognitive impairment identified in the preoperative or post-operative period. After surgical operations, older patients are particularly vulnerable to memory disturbances and other types of cognitive impairment. However, the pathogenesis of POCD remains unclear and no confirmed preventable or treatment strategy avilable. Our previous study demonstrated that the concentration of choline acetyl transferase in the cerebral spinal fliud was a predictive factor of POCD, and donepezil is an acetylcholinesterase inhibitor which was used in clinical for the treatment of alzheimer's disease can prevent the learning and memory impairment after anesthesia/surgery in aged mice. This study aimed to determine the critical role of donepezil in preventing cognitive impairment in elder patients undergoing orthopaedic surgery. Methods A multicentre, double-blind, placebo-controlled, crossover clinical trial will be performed to assess the efficacy of donepezil in elderly patients undergoing orthopaedic surgery. Participants (n = 360) will receive donepezil (5 mg once daily) or placebo from 1 day prior to surgery until 5 days after surgery. Neuropsychological tests will be measured at 1 day before the operation and 1 week, 1 month, 6 months and 1 year after the operation. Discussion This research project mainly aimed to study the effects of donepezil in elderly patients undergoing orthopaedic surgery due to underlying POCD and to investigate the underlying physiological and neurobiological mechanisms of these effects. The results may provide important implications for the development of effective interfering strategies, specifically regarding cognitive dysfunction therapy using drugs. Trial registration: ClinicalTrials.gov, NCT04423276. Registered on 14 June 2020.

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