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Flumazenil for Benzodiazepine Reversal in Electroconvulsive Therapy (FLEET)

27 maggio 2026 aggiornato da: Anders Jørgensen

Flumazenil for Benzodiazepine Reversal in Electroconvulsive Therapy (FLEET): A Randomized Controlled Trial

The goal of this study is to investigate whether administering flumazenil to reverse the effects of benzodiazepines and/or zopiclone during electroconvulsive therapy (ECT) can help reduce cognitive side effects without diminishing treatment effectiveness in hospitalized patients with depression.

The investigators hypothesize that blockade of the GABA receptor with flumazenil will reduce cognitive side effects through improved seizures and a reduced need for electrical charge escalation during the ECT series. Cognitive side effects will be measured by the total score on the Screening for Cognitive Impairment in Psychiatry (SCIP) (primary outcome) at follow-up after completion of the ECT series. Furthermore, it is expected that the flumazenil strategy will reduce pre-treatment anxiety and improve patient satisfaction (secondary outcomes). In addition, flumazenil strategy is hypothesized to have beneficial effects on subjective cognitive complaints, autobiographical memory, and executive functioning (secondary outcomes). Finally, the flumazenil strategy is expected to be associated with more favorable structural and functional changes in executive functioning and memory-related brain networks after completion of the ECT series, which may, in turn, be linked to better overall cognition and autobiographical memory (secondary outcome measures). For exploratory purposes, the study will also examine longitudinal changes in depressive symptoms and cognitive outcomes from baseline to follow-up (tertiary outcomes).

Investigators will compare two different pre-ECT benzodiazepine management strategies:

  1. Flumazenil strategy (experimental): continued benzodiazepine and/or zopiclone use up until the time of the ECT session, followed by administration of flumazenil immediately prior to ECT
  2. Benzodiazepine withholding strategy (treatment as usual):

discontinuation of benzodiazepines and/or zopiclone prior to the ECT in accordance with standard clinical practice

Panoramica dello studio

Stato

Reclutamento

Condizioni

Intervento / Trattamento

Descrizione dettagliata

The study will include adult inpatients (≥18 years of age) diagnosed with a mood disorder (major depressive disorder or bipolar disorder), currently experiencing a depressive episode (ICD-10: F31.3-5, F32 or F33), who are deemed eligible for ECT by a treating psychiatrist who is not affiliated with the study. Based on a power analysis, 132 participants (66 per group) are required to achieve adequate statistical power. To account for an anticipated 10% dropout rate from baseline to follow-up, the investigators will recruit 145 participants. Recruitment will be carried out through psychiatric hospital wards within the Mental Health Services of the Capital Region of Denmark.

Participants will be randomized following an initial screening to confirm eligibility. Randomization will be conducted using the automated randomization module in the Research Electronic Data Capture (REDCap) system, based on a pre-generated randomization list with variable block sizes of two and four. Allocation will be stratified by age (< 60 or ≥ 60 years) and electrode placement (unilateral vs. bilateral). Randomization will occur no later than the day prior to the second ECT session of the treatment series. Primary outcome assessors are blinded to the group allocation.

Baseline assessments will be conducted the day before the first ECT session or, if not otherwise possible, the day before the second ECT session. Participants will complete a brief neuropsychological assessment comprising the Screen for Cognitive Impairment in Psychiatry (SCIP) and additional measures of executive functioning and autobiographical memory. Participants will also complete self-report questionnaires assessing subjective cognitive complaints. Depressive symptom severity will be rated using the Hamilton Depression Rating Scale (HDRS).

During the ECT treatment series, repeated assessments will be conducted for each session. Participants will provide self-reported ratings of pre-treatment anxiety shortly before the session, while clinicians will record measures of seizure architecture, and time to reorientation following the session.

Follow-up assessments will be conducted 3-7 days after completion of the ECT-series, which serves as the primary end point. At follow-up, the brief neuropsychological assessment, self-report questionnaires, and HDRS ratings will be repeated. Participants will also complete a short self-report questionnaire of their treatment satisfaction. Structural and functional magnetic resonance imaging (MRI) is conducted within the 3-7 days after completion of the ECT series, coinciding with the follow-up assessment.

Tipo di studio

Interventistico

Iscrizione (Stimato)

145

Fase

  • Non applicabile

Contatti e Sedi

Questa sezione fornisce i recapiti di coloro che conducono lo studio e informazioni su dove viene condotto lo studio.

Contatto studio

Backup dei contatti dello studio

Luoghi di studio

  • Danimarca
    • Capital Region
      • Frederiksberg, Capital Region, Danimarca, 2000
        • Reclutamento
        • Mental Health Centre Copenhagen, Bispebjerg and Frederiksberg Hospital

Criteri di partecipazione

I ricercatori cercano persone che corrispondano a una certa descrizione, chiamata criteri di ammissibilità. Alcuni esempi di questi criteri sono le condizioni generali di salute di una persona o trattamenti precedenti.

Criteri di ammissibilità

Età idonea allo studio

  • Adulto
  • Adulto più anziano

Accetta volontari sani

No

Descrizione

Inclusion criteria:

  • Current depressive episode (unipolar or bipolar), corresponding to ICD-10 codes F31.3-5, F32 or F33.
  • Admitted at a study affiliated department in the Mental Health Services of the Capital Region of Denmark
  • Referred to ECT by the regular psychiatrist and has given consent to ECT
  • Currently receiving treatment with a benzodiazepine and/or zopiclone, at a minimum daily dose equivalent to 0.5 mg lorazepam.

Exclusion criteria:

  • Involuntary treatment with ECT
  • Known gross abnormalities in brain structure deemed likely to influence cognitive functioning
  • Pregnancy or breast-feeding
  • Inability to read or understand Danish
  • Acute organic brain disease (e.g., delirium) influencing the ability to give informed consent
  • Any pre-existing condition associated with an increased risk of prolonged or uncontrollable seizures, including but not limited to epilepsy or alcohol- or benzodiazepine withdrawal states
  • Conditions associated with reduced metabolism of flumazenil (e.g., liver failure)

Piano di studio

Questa sezione fornisce i dettagli del piano di studio, compreso il modo in cui lo studio è progettato e ciò che lo studio sta misurando.

Come è strutturato lo studio?

Dettagli di progettazione

  • Scopo principale: Trattamento
  • Assegnazione: Randomizzato
  • Modello interventistico: Assegnazione parallela
  • Mascheramento: Separare

Armi e interventi

Gruppo di partecipanti / Arm
Intervento / Trattamento
Sperimentale: Flumazenil for benzodiazepine reversal
Participants continue benzodiazepine and/or zopiclone treatment up until the ECT session, receiving flumazenil to reverse their effects
Droga: Flumazenil
The intervention involves continuation of benzodiazepine and/or zopiclone treatment up to the time of ECT, followed by administration of flumazenil immediately prior to anesthesia to transiently reverse the effect of benzodiazepines and/or zopiclone. Otherwise, ECT is administered according to standard clinical procedures.
Comparatore attivo: Treatment as usual (benzodiazepine hold)
Participants discontinue benzodiazepine and/or zopiclone treatment the day prior to the ECT session.
Procedura: Electroconvulsive therapy (ECT)
Standard ECT treatment performed in accordance with clinical practice, with benzodiazepines and/or zopiclone withheld after 5:00 p.m. on the day before each session

Cosa sta misurando lo studio?

Misure di risultato primarie

Misura del risultato
Misura Descrizione
Lasso di tempo
Screen for Cognitive Impairment in Psychiatry (SCIP)
Lasso di tempo: Baseline (the day before the first or second session in the ECT series) and follow-up (3-7 days after completion of the ECT series)
The primary outcome measure is the total score on the SCIP at follow-up (post-ECT). The SCIP is a brief neuropsychological assessment tool designed to detect cognitive deficits in individuals with psychotic and affective disorders. It comprises five subtests assessing key cognitive domains: verbal learning and memory (VLT-I and VLT-D), working memory (WMT), verbal fluency (VFT), and processing speed (PST). The total score provides a broad indicator of overall cognitive functioning. Higher scores mean a better outcome.
Baseline (the day before the first or second session in the ECT series) and follow-up (3-7 days after completion of the ECT series)

Misure di risultato secondarie

Misura del risultato
Misura Descrizione
Lasso di tempo
Hamilton Depression Rating Scale (HDRS)
Lasso di tempo: Baseline (the day before the first or second session in the ECT series) and follow-up (3-7 days after completion of the ECT series)
Clinician-administered depression assessment scale of 17 items. Score range: 0-52. Clinical response at follow-up (primary endpoint) is assessed using the HAM-D6 subscale, collectively comprising the core symptoms of depression with score range: 0-22. Higher scores mean a worse outcome.
Baseline (the day before the first or second session in the ECT series) and follow-up (3-7 days after completion of the ECT series)
Cognitive Complaints in Bipolar Disorder Rating Scale (COBRA)
Lasso di tempo: Baseline (the day before the first or second session in the ECT series) and follow-up (3-7 days after completion of the ECT series)
Self-report questionnaire assessing subjective cognitive complaints. Score range: 0-48. Higher scores mean a worse outcome.
Baseline (the day before the first or second session in the ECT series) and follow-up (3-7 days after completion of the ECT series)
Squire Subjective Memory Questionnaire (SSMQ)
Lasso di tempo: Baseline (the day before the first or second session in the ECT series) and follow-up (3-7 days after completion of the ECT series)
Self-report questionnaire assessing subjective memory complaints. Score range: -72 - +72. Higher (more positive) scores mean a better outcome.
Baseline (the day before the first or second session in the ECT series) and follow-up (3-7 days after completion of the ECT series)
Autobiographical Memory Test (AMT)
Lasso di tempo: Baseline (the day before the first or second session in the ECT series) and follow-up (3-7 days after completion of the ECT series)
Neuropsychological instrument used to assess the ability to retrieve autobiographical memories and their specificity. Higher scores mean a better outcome.
Baseline (the day before the first or second session in the ECT series) and follow-up (3-7 days after completion of the ECT series)
Trail Making Test B (TMT-B)
Lasso di tempo: Baseline (the day before the first or second session in the ECT series) and follow-up (3-7 days after completion of the ECT series)
Neuropsychological test assessing executive function. Scored by time to completion. Higher scores mean a worse outcome.
Baseline (the day before the first or second session in the ECT series) and follow-up (3-7 days after completion of the ECT series)
Verbal learning and memory (VLT-I)
Lasso di tempo: Baseline (the day before the first or second session in the ECT series) and follow-up (3-7 days after completion of the ECT series)
SCIP subtest assessing verbal learning and immediate recall. Score range: 0-30. Higher scores mean a better outcome.
Baseline (the day before the first or second session in the ECT series) and follow-up (3-7 days after completion of the ECT series)
Delayed verbal recall (VLT-D)
Lasso di tempo: Baseline (the day before the first or second session in the ECT series) and follow-up (3-7 days after completion of the ECT series)
SCIP subtest assessing delayed verbal recall. Score range: 0-10. Higher scores mean a better outcome.
Baseline (the day before the first or second session in the ECT series) and follow-up (3-7 days after completion of the ECT series)
Working memory test (WMT)
Lasso di tempo: Baseline (the day before the first or second session in the ECT series) and follow-up (3-7 days after completion of the ECT series)
SCIP subtest assessing working memory capacity. Score: 0-24. Higher scores mean a better outcome.
Baseline (the day before the first or second session in the ECT series) and follow-up (3-7 days after completion of the ECT series)
Verbal fluency test (VFT)
Lasso di tempo: Baseline (the day before the first or second session in the ECT series) and follow-up (3-7 days after completion of the ECT series)
SCIP subtest assessing verbal fluency. No score range. Higher scores mean a better outcome.
Baseline (the day before the first or second session in the ECT series) and follow-up (3-7 days after completion of the ECT series)
Processing speed test (PST)
Lasso di tempo: Baseline (the day before the first or second session in the ECT series) and follow-up (3-7 days after completion of the ECT series)
SCIP subtest assessing processing speed. Score range: 0-30. Higher scores mean a better outcome.
Baseline (the day before the first or second session in the ECT series) and follow-up (3-7 days after completion of the ECT series)
Patient Satisfaction Survey (PSS)
Lasso di tempo: Follow-up (3-7 days after completion of the ECT series)
Self-report questionnaire assessing patient satisfaction following ECT treament. A subset of items are used. Higher scores mean a better outcome.
Follow-up (3-7 days after completion of the ECT series)
Visual Analogue Scale for Anxiety (VAS-A)
Lasso di tempo: Per ECT session
Visual analogue self-report scale assessing anxiety severity within the last 24 hours. Score range: 0-100. Higher scores mean a worse outcome.
Per ECT session
Time to reorientation
Lasso di tempo: Per ECT session
Clinician-administered structured interview measuring time to reorientation (in minutes) according to Sobin et al. (1995) and Stuiver et al. (2024). Patients are screened every 5 minutes after EEG-offset for orientation in five domains: name, location, age, date of birth, and day of the week. Reorientation is defined as the time in minutes from EEG-offset until the patient provides at least 4 out of 5 correct answers. If the patient fails to reach reorientation within 60 minutes, a score of 70 minutes is registered. Higher scores indicate a longer recovery period and a worse outcome.
Per ECT session
Seizure quality
Lasso di tempo: Per ECT session
Clinician-rated categorical EEG classification of seizure quality (A, A-T, T, O, S). A-seizures represent the optimal therapeutic pattern.
Per ECT session
Seizure length (EEG)
Lasso di tempo: Per ECT session
EEG seizure duration (seconds) from the end of stimulation to the last unequivocal ictal discharge. Continuous physiological measure.
Per ECT session
Stimulus dose
Lasso di tempo: Per ECT session
Stimulus dose recorded as the percentage of the device's maximum output (%) delivered during each treatment, as displayed on the ECT device readout. Range: 0-200%.
Per ECT session
Prefrontal and medial temporal activation during autobiographical memory retrieval
Lasso di tempo: Follow-up (3-7 days after completion of the ECT series)
Functional magnetic resonance imaging (fMRI) measure of brain activity during an autobiographical memory test
Follow-up (3-7 days after completion of the ECT series)
Prefrontal, parietal and medial temporal activation during memory encoding
Lasso di tempo: Follow-up (3-7 days after completion of the ECT series)
Functional magnetic resonance imaging (fMRI) measure of brain activity during a memory encoding task
Follow-up (3-7 days after completion of the ECT series)
Prefrontal and parietal activation during spatial N-back
Lasso di tempo: Follow-up (3-7 days after completion of the ECT series)
Functional magnetic resonance imaging (fMRI) measure of brain activity during a working memory task
Follow-up (3-7 days after completion of the ECT series)

Collaboratori e investigatori

Qui è dove troverai le persone e le organizzazioni coinvolte in questo studio.

Sponsor

Anders Jørgensen

Investigatori

  • Investigatore principale: Anders Jørgensen, MD, Ph.D., Mental Health Services of the Capital Region

Studiare le date dei record

Queste date tengono traccia dell'avanzamento della registrazione dello studio e dell'invio dei risultati di sintesi a ClinicalTrials.gov. I record degli studi e i risultati riportati vengono esaminati dalla National Library of Medicine (NLM) per assicurarsi che soddisfino specifici standard di controllo della qualità prima di essere pubblicati sul sito Web pubblico.

Studia le date principali

Inizio studio (Effettivo)

15 gennaio 2026

Completamento primario (Stimato)

1 agosto 2028

Completamento dello studio (Stimato)

1 agosto 2028

Date di iscrizione allo studio

Primo inviato

24 settembre 2025

Primo inviato che soddisfa i criteri di controllo qualità

27 maggio 2026

Primo Inserito (Effettivo)

1 giugno 2026

Aggiornamenti dei record di studio

Ultimo aggiornamento pubblicato (Effettivo)

1 giugno 2026

Ultimo aggiornamento inviato che soddisfa i criteri QC

27 maggio 2026

Ultimo verificato

1 maggio 2026

Maggiori informazioni

Termini relativi a questo studio

Parole chiave

Termini MeSH pertinenti aggiuntivi

Altri numeri di identificazione dello studio

  • 2025-522506-20-00

Informazioni su farmaci e dispositivi, documenti di studio

Studia un prodotto farmaceutico regolamentato dalla FDA degli Stati Uniti

No

Studia un dispositivo regolamentato dalla FDA degli Stati Uniti

No

Queste informazioni sono state recuperate direttamente dal sito web clinicaltrials.gov senza alcuna modifica. In caso di richieste di modifica, rimozione o aggiornamento dei dettagli dello studio, contattare register@clinicaltrials.gov. Non appena verrà implementata una modifica su clinicaltrials.gov, questa verrà aggiornata automaticamente anche sul nostro sito web .

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