Clinical Research Directory

EEG Microstate and Neuroinflammatory Biomarkers in Older Age Patients With Major Depressive Disorder Receiving ECT

This study aims to investigate the neurophysiological and inflammatory changes associated with electroconvulsive therapy (ECT) in older age patients diagnosed with Major Depressive Episode, Major Depression, and Bipolar Disorder, using microstate analysis derived from resting-state electroencephalography (EEG) recordings. Within this scope, EEG recordings obtained before and after ECT will be compared to determine the relationships between changes in microstate parameters and inflammatory marker levels, clinical variables, and psychometric scale scores reflecting clinical improvement. Peripheral blood samples collected from the same patient group will be analyzed for complete blood count parameters as well as levels of interleukin-1 alpha (IL-1α), interleukin-1 beta (IL-1β), interleukin-2 (IL-2), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-α), soluble glycoprotein 130 (sgp-130), soluble interleukin-6 receptor (sIL-6R), interferon gamma-induced protein 10 kDa (IP-10), and C-reactive protein (CRP). In addition, inflammatory indices, including the Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Monocyte-to-Lymphocyte Ratio (MLR), will be calculated. The association between baseline levels of these biomarkers and treatment response will be evaluated. Moreover, changes in biomarker levels following ECT will be statistically examined in relation to clinical scale scores and EEG microstate parameters. Although microstate analysis and inflammatory biomarkers have each been extensively investigated in psychiatric disorders, studies evaluating these two biomarkers together, particularly with the inclusion of healthy control participants, in the older age population remain limited. In this regard, the present study aims to evaluate the effects of ECT on older age patients using objective neurophysiological indicators, contribute to the understanding of the pathophysiology of depression at the level of brain networks, and provide a scientific basis for the development of personalised treatment approaches in the future.

Low Frequency Right Dorsolateral Pre Frontal Cortical Repetitive TMS for Bipolar Depression

The purpose of this trial is to conduct an adequately powered clinical trial of once daily LFR for individuals diagnosed with treatment-resistant BD-DE who have not responded to iTBS or sham treatment applied to the left DLPFC. This work will develop the evidence supporting the use of LFR rTMS for individuals with treatment-resistant BD-DE who currently have limited treatment options to alleviate their suffering. Participants will come for 30 days of LFR, with a 6-week follow-up period. Symptoms of depression (for determining treatment efficacy) and mania (for determining treatment safety) will be assessed using the 17-item Hamilton Rating Scale for Depression (HRSD-17) and the Young Mania Rating Scale (YMRS) every five treatments during the treatment course, and at 1 week and 6 week after treatment completion.

Treatment Response In ECT Patients

Clarification Regarding Study Type: Observational This study is a prospective, non-interventional observational study. The decision to administer Electroconvulsive Therapy (ECT) and the selection of the anesthetic agent (ketamine + propofol or propofol alone) are made entirely by the treating psychiatrist as part of routine clinical practice, independent of and prior to any research-related activities. Participants are not assigned to anesthetic groups by the investigators; rather, they are observed and grouped according to the anesthetic regimen already determined by their clinical team based on standard medical care. The investigators do not intervene in, alter, or influence the treatment process in any way. Data collection consists solely of administering validated psychiatric rating scales at predefined time points to monitor naturally occurring clinical outcomes. Therefore, this study meets the definition of an observational study as outlined in the Protocol Registration Data Element Definitions: participants receive interventions as part of routine medical care, and the researcher studies the effect of the intervention without assigning it. Summary of the Study This research project, titled "A Prospective Observational Study of Suicidal Ideation, Dissociative Symptoms, and Treatment Response in Psychiatric Patients Receiving Electroconvulsive Therapy (ECT)", aims to investigate clinical outcomes associated with different anesthetic agents used during ECT in patients diagnosed with Major Depressive Disorder (MDD) or Bipolar Depression. As these disorders constitute some of the most disabling psychiatric conditions globally, effective and timely treatment remains critical. Despite the widespread use of antidepressant medications, a substantial proportion of patients-particularly those classified under Treatment-Resistant Depression (TRD)-fail to achieve adequate remission. For such individuals, ECT continues to be one of the most reliable and evidence-based therapeutic options. The study focuses on how anesthetic choice during ECT influences three key clinical parameters: Depression severity, Suicidal ideation, and Dissociative symptoms. Ketamine, an NMDA receptor antagonist, has gained particular interest due to its rapid antidepressant properties and unique neurobiological profile. It has shown promise in reducing depressive symptoms more quickly than traditional anesthetic agents, although it may also trigger transient dissociative experiences. In contrast, propofol-another commonly used anesthetic during ECT-has more neutral sedative characteristics and lacks the rapid antidepressant effects attributed to ketamine. Understanding how these anesthetics influence clinical trajectories during ECT may help optimize treatment approaches for complex depressive disorders. This non-interventional, prospective observational study will include 65 patients aged 18-65, all of whom meet DSM-5 criteria for MDD or Bipolar Disorder in a depressive episode and have an established clinical indication for ECT. Participants will be assigned naturally, based on clinical practice, to one of two groups: Ketamine + Propofol anesthesia group (n=30) Propofol-only anesthesia group (n=35) Researchers will not intervene in the anesthesia selection process. Instead, they will observe and measure clinical progress using validated psychiatric assessment tools: Montgomery-Åsberg Depression Rating Scale (MADRS) for depression severity, Beck Suicidal Ideation Scale (BSI) for suicidal thoughts and planning, and Clinician-Administered Dissociative States Scale (CADSS) for dissociative symptoms such as depersonalization, derealization, and amnesia. Assessments will be conducted at four time points to monitor the evolution of symptoms during treatment: Before initiation of ECT, After the first ECT session, After the third ECT session, At the completion of the full ECT course. By comparing these clinical measurements across different anesthetic groups, the research seeks to determine whether ketamine offers measurable advantages in terms of speed of antidepressant response, reduction in suicidal thoughts, or increase in dissociative phenomena, compared with propofol. Prior studies have suggested that ketamine may produce faster mood improvement, especially in TRD, but may also lead to short-term cognitive and perceptual disturbances. This study will contribute real-world data from a psychiatric inpatient population undergoing standardized ECT procedures. The expected outcome is a clearer understanding of how anesthetic choice influences the clinical course of patients undergoing ECT for depressive disorders. Such knowledge has the potential to guide personalized treatment strategies, optimize patient safety, and improve outcomes for individuals who have not responded to standard pharmacological interventions. Additionally, identifying dissociative responses linked specifically to ketamine may help clarify whi