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Antidepressant and Neurocognitive Effects of Isoflurane Anesthesia versus Electroconvulsive Therapy in Refractory Depression.doc

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Antidepressant and Neurocognitive Effects of Isoflurane Anesthesia versus Electroconvulsive Therapy in Refractory Depression

AntidepressantandNeurocognitiveEffectsofIsoflurane AnesthesiaversusElectroconvulsiveTherapyin RefractoryDepression HowardR.WeeksIII1*,ScottC.Tadler2,KellyW.Smith2,EliIacob2,3,MikalaSaccoman4, AndreaT.White2,5,JoshuaD.Landvatter2,GordonJ.Chelune6,YanaSuchy6,7,ElaineClark4, MichaelK.Cahalan2,LowryBushnell1,DerekSakata2,AlanR.Light2,3,KathleenC.Light2 1DepartmentofPsychiatry,UniversityNeuropsychiatricInstitute,UniversityofUtahSchoolofMedicine,SaltLakeCity,Utah,UnitedStatesofAmerica,2Departmentof Anesthesiology,UniversityofUtahSchoolofMedicine,SaltLakeCity,Utah,UnitedStatesofAmerica,3NeuroscienceProgram,UniversityofUtahSchoolofMedicine,Salt LakeCity,Utah,UnitedStatesofAmerica,4DepartmentofEducationalPsychology,CollegeofEducation,UniversityofUtah,SaltLakeCity,Utah,UnitedStatesofAmerica, 5DepartmentofExerciseandSportScience,CollegeofHealth,UniversityofUtah,SaltLakeCity,Utah,UnitedStatesofAmerica,6DepartmentofNeurologyandCenter forAlzheimer’sCare,ImagingandResearch,UniversityofUtahSchoolofMedicine,SaltLakeCity,Utah,UnitedStatesofAmerica,7DepartmentofPsychology,Collegeof SocialandBehavioralScience,UniversityofUtah,SaltLakeCity,Utah,UnitedStatesofAmerica Abstract Background: Many patients have serious depression that is nonresponsive to medications, but refuse electroconvulsive therapy (ECT). Early research suggested that isoflurane anesthesia may be an effective alternative to ECT. Subsequent studies altered drug, dose or number of treatments, and failed to replicate this success, halting research on isoflurane’s antidepressanteffectsforadecade.Ouraimwastore-examinewhetherisofluranehasantidepressanteffectscomparableto ECT,withlessadverseeffectsoncognition. Method:Patientswithmedication-refractorydepressionreceivedanaverageof10treatmentsofbifrontalECT(n=20)or isoflurane(n=8)over3weeks.Depressionseverity(HamiltonRatingScaleforDepression-24)andneurocognitiveresponses (anterograde and retrograde memory, processing speed and verbal fluency) were assessed at Pretreatment, Post