***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Electroconvulsive therapy ( ECT ) is one of the available and the most effective therapies for the treatment of resistant depression . Considering the crucial role of seizure duration on therapeutic response in patients treated with ECT , this study aim ed to compare the effect of ketamine and sodium thiopental anesthesia during ECT for treatment of patients with drug-resistant major depression ( DRMD ) . Material s and Methods : In a double-blind r and omized clinical trial , 160 patients with DRMD were selected consequently and were assigned r and omly into two groups including ketamine 0.8 mg/kg and sodium thiopental 1.5 mg/kg . The seizure duration , recovery time , and the side effects of anesthesia were evaluated after 1-h after anesthesia . Data of recovery time and complication collected in 2nd , 4th , 6th , and 8th ECT . Depression was assessed by Hamilton depression scale . Results : The results indicated that ketamine and sodium thiopental had a significant effect on the reduction of depression scores in patients with DRMD ( P < 0.05 ) . Complications such as a headache , nausea , pain at the injection site , short-term delirium , and long-term delirium were higher in ketamine group ( P > 0.05 ) . But ketamine was more effective in improvement of depression score and increasing systolic and diastolic blood pressure ( P < 0.05 ) . The mean of seizure duration showed a decreasing trend and was significant between two study groups ( P < 0.05 ) . Conclusion : Anesthesia induced by ketamine during ECT therapy increased blood pressure and seizure duration . Therefore , due to lower medical complication and attack rate of seizure , ketamine is an appropriate option for anesthesia with ECT in patients with DRMD Background : ADHD involves impairing core symptoms of inattention and hyperactivity/impulsivity in children ( childhood ADHD = CH ) that may persist in adulthood ( adult ADHD = AD ) . Conflicting findings have been found regarding AD prevalences among adult smokers , and it is unclear whether AD is associated with a more severe smoking behavior in adulthood . Objective : The aim of this article is ( a ) to determine CH and AD prevalences in a nonselected sample of adult smokers , ( b ) to describe the characteristics of smokers with ADHD symptoms versus those without , and ( c ) to determine whether CH and /or AD symptoms are risk factors for more severe smoking in adulthood . Method : Three hundred and seventy-three participants aged 18 years and over were prospect ively recruited in a smoking-cessation unit . Participants were classified as “ no ADHD symptoms , ” “ CH symptoms , ” or “ AD symptoms ” according to their baseline score on the Wender Utah Rating Scale ( WURS ) alone ( for CH symptoms ) and WURS combined to the Adult Self Report Scale ( ASRS ) for AD symptoms . Other clinical variables were reported at first consultation . Results : ( a ) CH symptoms were reported in 15.3 % ( 57/373 ) of the total sample , 42.1 % ( 24/57 ) of whom also had persistent ADHD symptoms in adulthood ( prevalence of AD was 24/373 = 6.4 % ) . ( b ) In comparison with participants without ADHD symptoms , smokers with ADHD symptoms consume significantly more tobacco , but ADHD symptoms were no longer significantly associated with the daily number of smoked cigarettes after adjustment for sociodemographic variables . No significant association was found between the two groups and age at the first cigarette , age at onset daily smoking , and nicotine dependence . ( c ) Participants were categorized into three groups : Group 1 without ADHD symptoms lifetime ( NH ; n = 316 ) , Group 2 with childhood history of ADHD symptoms ( CH ; n = 33 ) , and Group 3 with Adult ADHD symptoms ( AD ; n = 24 ) . The association with tobacco consumption ( > 20 cigarettes/day ) was significant for CH only ( p = .02 ) . After adjustment for gender , age , professional status , and educational level , this association was not longer significant . Conclusion : Childhood and adult ADHD symptoms are both highly prevalent among nonselected smokers but our study failed to show more severe smoking characteristics among these participants after adjustment with sociodemographic variables Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Objectives Recently , ketamine has attracted attention for induction of anesthesia during electroconvulsive therapy ( ECT ) . This study compared the effects of thiopental and ketamine in patients undergoing this procedure . Method This r and omized , double-blind clinical trial included in patients , with major depressive disorder , undergoing ECT .  Subjects were r and omly allocated to receive either ketamine or thiopental .  Mini-Mental State Examination and Hamilton Depression Rating Scale were used to assess memory and depression , respectively , before the first and second ECT sessions as well as a few days and 1 month after the sixth session . The electrical charge , seizure duration , blood pressure , and heart rate were also recorded . Results Of the 31 patients , 17 met the criteria for the ketamine group but 2 dropped out of the study . Therefore , 15 patients received ketamine and 14 received thiopental . Each patient underwent 6 ECT sessions . At the end of the study , depression improved significantly in both groups . However , a significant difference in depression improvement was noted only before the second ECT with ketamine compared with thiopental . Despite a significant decline in Mini-Mental State Examination scores in both groups after the first ECT , cognitive function improved afterward but was only significant in ketamine group . Seizure duration was found to be significantly longer with ketamine .  Stimulus intensity used for each ECT increased gradually and linearly with a greater increase observed in thiopental group . Conclusions Ketamine administration during ECT is well tolerated and patients may experience earlier improvement in depressive symptoms , longer seizure duration , and better cognitive performance when compared with thiopental Background : Propofol is often used as an anesthetic agent for electroconvulsive therapy ( ECT ) . Whether the relatively short seizure duration , result ing from the medication , deteriorates the seizure quality and therapeutic outcomes , or whether propofol might be associated with small but significant post-ECT cognitive impairments , is still a subject of controversy . The purpose of our study was to test these hypotheses in comparison with methohexital . Material s and Methods : In a double-blind , controlled study , 50 patients with severe major depression who were to be treated with ECT  were r and omly assigned to anesthesia with propofol ( 120.9 ± 50.0 mg ) or methohexital ( 83 ± 26.3 mg ) and were observed for 2 months . The 2 drugs were compared on the basis of electroencephalography-registered seizure duration , mean blood pressure , as well as pulse frequency , seizure efficacy index , and postictal suppression . Systolic and diastolic blood pressure , and seizure duration and quality were recorded consecutively during ECT treatments . Changes in depressive symptoms and cognitive functions were measured at 5 time points , pre-ECT , after the third to fifth ECT , post-ECT treatment , and at a follow-up examination 2 and 8 weeks after the last ECT treatment . Results : Patients on propofol showed a significantly lower increase in blood pressure post-ECT ( P < 0.001 ) , their seizure duration was comparable to patients on methohexital ( P = 0.072 ) , and seizure quality was significantly superior , as was measured by the Postictal Suppression Index ( P = 0.020 ) , and comparable to the methohexital group as measured by the Seizure Efficacy Index ( P = 0.160 ) . The improvement of depressive symptoms and the improvement in cognitive functions were similar in both groups ( with the exception of the results from 2 cognition tests ) . Conclusions : Propofol , as compared with methohexital , results in a more moderate increase in blood pressure and shorter seizure duration . The seizure quality did not differ significantly between the 2 groups . We detected a tendency toward improved cognitive performance after anesthesia with propofol as compared with methohexital , but with statistical significance in only 2 cognition trials . Therefore , propofol is a safe and efficacious anesthetic for ECT treatment Background Electroconvulsive therapy ( ECT ) is a preferred therapy for major depressive disorder . Intravenous propofol , a sedative and hypnotic agent , is one of the choices of anesthetic for ECT . Ketamine , another anesthetic agent , providing sedation , amnesia , and analgesia , can also be used in patients undergoing ECT  owing to its rapid action and persistent antidepressive effect . One adverse effect of ketamine is cardiovascular excitement , which may be reduced by propofol . Currently , the effects of combined anesthesia ( propofol and ketamine ) for patients with depressive disorder who have undergone ECT are unclear . The purpose of this study was to investigate the effects of the combined agents for patients undergoing ECT . Methods Forty-eight patients with Hamilton Depression Rating Scale ( HDRS ) scores greater than 20 were r and omly divided into 3 groups ( n = 16 each ) : propofol group ( group P ) , ketamine group ( group K ) , and propofol plus ketamine group ( group PK ) . Propofol ( 1.5 mg/kg ) , ketamine ( 0.8 mg/kg ) , and propofol ( 1.5 mg/kg ) plus ketamine ( 0.8 mg/kg ) were infused to each group of patients , respectively , before ECT by an anesthesiologist with no knowledge of the HDRS score . For the purpose of this study , the patients received a single ECT treatment and were assessed for depression using the HDRS scores ( 1 day before ECT and days 1 , 2 , 3 , and 7 after the ECT treatment ) by a psychiatrist with no knowledge of the r and omization group . After the final assessment , the patients received further treatment as needed up to 3 treatments per week . Seizure energy index , seizure duration , and adverse effects were observed during anesthesia by a nurse with no knowledge of the study group . Results The HDRS scores improved earlier in group K and group PK . Decreases in HDRS scores were significantly greater in group K and group PK compared with those in group P. The adverse effects in group PK were fewer than those in group K. Seizure energy index and seizure duration in group K and group PK were higher and longer than those in group P during ECT . Conclusion The results suggested that propofol combined with ketamine anesthesia might be the first-choice anesthesia in patients with depressive disorder undergoing ECT Objectives Studies now provide strong evidence that the N-methyl-D-aspartate receptor antagonist ketamine possesses rapidly acting antidepressant properties . This study aim ed to determine if a low dose of ketamine could be used to expedite and augment the antidepressant effects of electroconvulsive therapy ( ECT ) treatments in patients experiencing a severe depressive episode . Material s and Methods Subjects with major depressive disorder or bipolar disorder referred for ECT treatment of a major depressive episode were r and omized to receive thiopental alone or thiopental plus ketamine ( 0.5 mg/kg ) for anesthesia before each ECT session . The Hamilton Depression Rating Scale ( HDRS ) was administered at baseline and at 24 to 72 hours after the first and sixth ECT sessions . Results Electroconvulsive therapy exerted a significant antidepressant effect in both groups ( F2,24 = 14.35 , P < 0.001 ) . However , there was no significant group effect or group-by-time interaction on HDRS scores . In addition , post hoc analyses of the time effect on HDRS showed no significant HDRS reduction after the first ECT session for either group . Conclusions The results of this pilot study suggest that ketamine , at a dose of 0.5 mg/kg , given just before ECT , did not enhance the antidepressant effect of ECT . Interestingly , the results further suggest that the coadministration of ketamine with a barbiturate anesthetic and ECT may attenuate the immediate antidepressant effects of the N-methyl-D-aspartate antagonist Objectives : To compare propofol and thiopental as anesthetic agents for  electroconvulsive therapy ( ECT ) with respect to seizure duration , stimulus charge , and clinical effects . Material s and Methods : R and omized , blinded study of 28 patients of depression treated with bilateral ECT .  In group P ( n = 14 ) , sedation was achieved with propofol 1.5 mg/kg , whereas in group T ( n = 14 ) , it was achieved with thiopentone 3 mg/ kg IV . Succinylcholine 0.4 mg/kg intravenous was given in all patients as for neuromuscular blockade . Results : The mean seizure duration of the patients in the thiopental group was 83 ± 34.43 seconds vs. 94.45 ± 21.37 seconds in the propofol group ( P < 0.01 ) . The energy delivered per treatment was 10.88 ± 4.78 J in the thiopental group vs. 12.20 ± 4.53 J in the propofol group ( P < 0.05 ) . Number of ECTs required were 
    Output:
    
In summary , ketamine and methohexital may be preferred to propofol or thiopental in regard of effectiveness in depression scores and increased seizure duration .