Neural and Antidepressant Effects of Propofol

Aim 1: Compare the clinical antidepressant effects of propofol versus placebo.

Aim 2: Characterize the effects of propofol on brain function and gene expression.

Inclusion Criteria:

- Age 18-55

- Diagnosis of major depressive disorder or bipolar disorder

- Current moderate-to-severe depressive episode

- Episode duration more than 2 months and less than 5 years

- Failure of at least 2 adequate antidepressant medication trials within the past 2
years

- Body mass index < 40

- 16-item Quick Inventory of Depressive Symptomatology, self-rated > 10

Exclusion Criteria:

- Contraindication to propofol or midazolam

- Daily use of benzodiazepine, opioid, ACE inhibitor, or ARB medication

- Symptomatic coronary artery disease or heart failure

- Poorly controlled hypertension or diabetes

- Abnormal kidney or liver function

- Pregnant or breast feeding

- Traumatic brain injury or significant neurologic signs (past year)

- Substance use disorder (past year)

- Obsessive compulsive disorder (current)

- Post-traumatic stress disorder (current)

- Schizophrenia-spectrum disorder (lifetime)

- Neurocognitive disorder (current)

- Personality disorder as a current focus of treatment

- ECT within the past 3 months

- Inappropriate for ECT, or poor response to ECT within the past 5 years

- Incompetent to provide consent