Cognitive Recovery After Electroconvulsive Therapy and General Anesthesia

A cognitive test battery was administered at 0, 30, 60, 90, and 120 minutes following return of consciousness after general anesthesia on each treatment day (1-6). The data from each treatment day (1-6) were averaged for analyses. Cognition Test Battery: * Psychomotor Vigilance Task (PVT) * Digital Symbol Substitution Task (DSST) * Motor Praxis Task (MP) * Visual Object Learning Task (VOLT) * Abstract Matching (AM) Initial Decrement for this measure is defined as the difference between response times (in seconds) at baseline and t=0 for each task.

Time frame: 0, 30, 60, 90, 120 minutes following return of consciousness, assessed on treatment days 1-6.

Population: Participants with cogntive task data complete for the majority of timepoints following return of responsiveness for more than one treatment day were included in analyses. Additional participants were excluded for individual cognitive task measures for being extreme outliers.

A cognitive test battery was administered at 0, 30, 60, 90, and 120 minutes following return of consciousness after general anesthesia on each treatment day (1-6). The data from each treatment day (1-6) were averaged for analyses. Cognition Test Battery: * Psychomotor Vigilance Task (PVT) * Digital Symbol Substitution Task (DSST) * Motor Praxis Task (MP) * Visual Object Learning Task (VOLT) * Abstract Matching (AM) Rate of Recovery for this measure is defined as the time (in inverse hours) for participants to return to their baseline performance for each task.

Time frame: 0, 30, 60, 90, 120 minutes following return of consciousness, assessed on treatment days 1-6.

Population: Participants with cogntive task data complete for the majority of timepoints following return of responsiveness for more than one treatment day were included in analyses. Additional participants were excluded for individual cognitive task measures for being extreme outliers.

PROMIS-CAT (Patient Reported Outcomes Measurement Information System-Computer Adaptive Testing) for depression The groups/arms for this outcome are combined as a whole-group analysis due to the Crossover design of this study, as pre-specified by the study protocol. Breaking up the analyses into the various arms of the study would change our scientific questions and approach. Further, any statistical analyses would be underpowered due to low participant numbers in each arm. Thus, the results are combined and reported as a whole group analysis. All participants included in analyses completed all treatments included in the study, the various arms for the study vary only in the order in which participants received each treatment. These data show the change in mood from baseline to treatment 6 based on the PROMIS-CAT. Additionally, data collected at baseline are not dependent on the study group/arm.

Time frame: baseline and 120 minutes after return of responsiveness, assessed on treatment days 1-6

Population: All 13 participants who completed the depression PROMS-CAT both before and after treatment (baseline and 120 minutes following return of responsiveness) on at least one treatment day.

High-density EEG collected during 5-minute epochs of eyes-closed quiet resting at baseline and post-ECT. Results are reported as the percent of total power in the alpha band over the sum of total power between 0.5 - 70Hz.

Time frame: baseline, post-ECT from 0-120 minutes

Population: Participants with EEG data collected at baseline at T0 post-ECT for at least 1 ECT session were included in analyses.

High-density EEG collected during 5-minute epochs of eyes-closed quiet resting at baseline and post-ECT. Results are reported as the coherence measure, which is used for tracking changes in anterior-posterior functional connectivity. Coherence is a measure of synchronization between two signals which is used to measure anterior-posterior functional connectivity. Coherence is a unitless measure between 0 and 1. High coherence between time-series of two neural populations reflects higher efficiency in communication between those populations and therefore stronger functional connectivity.

Time frame: baseline, post-ECT from 0-120 minutes

Population: Participants with EEG data collected at baseline at T0 post-ECT for at least 1 ECT session were included in analyses.

High-density EEG collected during 5-minute epochs of eyes-closed quiet resting at baseline and post-ECT. Phase-lag was assessed using the Phase-Lag Index (PLI), a measure ranging from 0 - 1. A consistent phase-lag between two tim-series results in a PLI of 1. A time-series without coupling results in a PLI near or equaling 0. Results show the difference in anterior-posterior PLI between baseline and post-ECT.

Time frame: baseline, post-ECT from 0 -120 minutes

High-density EEG collected during 5-minute epochs of eyes-closed quiet resting at baseline and post-ECT. Results are reported as the percent of total power in the beta band over the sum of total power between 0.5 - 70Hz.

Time frame: baseline, post-ECT from 0-120 minutes

Population: Participants with EEG data collected at baseline at T0 post-ECT for at least 1 ECT session were included in analyses.

High-density EEG collected during 5-minute epochs of eyes-closed quiet resting at baseline and post-ECT. Results are reported as the percent of total power in the delta band over the sum of total power between 0.5 - 70Hz.

Time frame: baseline, post-ECT from 0-120 minutes

Population: Participants with EEG data collected at baseline at T0 post-ECT for at least 1 ECT session were included in analyses.

High-density EEG collected during 5-minute epochs of eyes-closed quiet resting at baseline and post-ECT. Results are reported as permutation entropy (PE) measures in posterior regions, which we are using to track changes in scalp EEG entropy. Permutation Entropy (PE) is a measure that is used to quantify the complexity of time series signals. It is a unitless measure between 0 and 1. Lower the PE represents a more regular and more deterministic time series while higher PE represents a more complex time series.

Time frame: baseline, Post-ECT from 0 -120 minutes

Population: Participants with EEG data collected at baseline at T0 post-ECT for at least 1 ECT session were included in analyses.

Mood Self-Assessment Manikin (SAM) Scale: 1 (very unpleasant) - 9 (very pleasant). The groups/arms for this outcome are combined as a whole-group analysis due to the Crossover design of this study, as pre-specified by the study protocol. Breaking up the analyses into the various arms of the study would change our scientific questions and approach. Further, any statistical analyses would be underpowered due to low participant numbers in each arm. Thus, the results are combined and reported as a whole group analysis. All participants included in analyses completed all treatments included in the study, the various arms for the study vary only in the order in which participants received each treatment. These data show the change in mood from baseline to treatment 6 based on the SAM. Additionally, data collected at baseline are not dependent on the study group/arm.

Time frame: baseline and 120 minutes after return of responsiveness, assessed on treatment days 1-6

Population: The average change in SAM score from baseline to t=120 for all sessions across all participants (t=120 - baseline).

High-density EEG collected during 5-minute epochs of eyes-closed quiet resting at baseline and post-ECT. Results are reported as the percent of total power in the theta band over the sum of total power between 0.5 - 70Hz.

Time frame: baseline, post-ECT from 0-120 minutes

Population: Participants with EEG data collected at baseline at T0 post-ECT for at least 1 ECT session were included in analyses.

Assessed using 3D Confusion Assessment Method (CAM). The groups/arms for this outcome are separated by anesthetic regimen; however, due to the crossover design of this study all participants are included in analyses for each group.

Time frame: Immediately following return of consciousness (t=0) during treatment days 1-6.

Population: All participants (12) who completed both baseline and t=0 delirium assessments on at least one treatment day.

The electrical dose necessary for seizure induction is determined during a dose-charge titration session prior to participant randomization and session 1. These results report the average electrical dose across all participants for the first treatment session during Treatment Week 1. The range for these data is 0 - 100% electrical charge.

Time frame: First ECT treatment session during Treatment Week 1

Population: Results are shown for all 13 participants who completed at least one treatment session following the dose charge titration session.

Duration (in seconds) of seizure induced by ECT treatment

Time frame: up to days 1-6

Population: These data were not collected from patient ECT procedure records and therefore were not analyzed.

To assess patient blinding of treatment performed, the patient will be asked: Based on how you feel, did you have ECT today? Results indicate participants correctly answering the subjective assessment.

Time frame: Assessed at 120 minutes after return of responsiveness on treatment days 1-6

Population: The sample analyzed for each group consists of the total number of treatments performed with paired subjective assessments out of 12 participants.

The groups/arms for this outcome are combined as a whole-group analysis due to the crossover design of this study, as pre-specified by the study protocol. Breaking up the analyses into the various arms of the study would change our scientific questions and approach. All participants included in analyses completed all treatments, the various arms for the study vary only in the order in which participants received each treatment. These data show the change in suicidality from baseline to treatment 6 based on the Scale of Suicide Ideation. The measure completed was the Scale of Suicide Ideation. For this study, participants completed the following questions of the questionnaire: 1. wish to live (0 Moderate to Strong, 1 Weak, 2 None) 2. wish to die (0 None, 1 Weak, 2 Moderate to Strong) The total scores range from 0-4. Lower scores indicate high suicide ideation, and high scores indicate low suicide ideation.

Time frame: assessed at baseline on treatment days 1-6.

Population: 114 Assessments of suicidality were completed across 13 participants on days 1-6. Data reported show the average change in suicidality from baseline to treatment 6 based on the Scale of Suicide Ideation.