Can Propofol Improve Sleep and Depression in Older Adults? A Clinical Trial Protocol

What you need to know

• Depression in older adults often resists standard treatments and can lead to cognitive decline
• Poor sleep, especially reduced slow wave sleep, may contribute to depression and memory problems
• This study tests if the anesthetic propofol can enhance slow wave sleep and improve depression symptoms

The Challenge of Treatment-Resistant Depression

Depression in older adults presents unique challenges - not only does it affect quality of life, but it can also accelerate cognitive decline and increase dementia risk. Unfortunately, nearly a third of patients don’t respond adequately to standard antidepressant medications. This “treatment-resistant depression” in older adults is particularly concerning as the population ages.

Current antidepressants typically target brain chemicals like serotonin and norepinephrine. While these help many people, we need new approaches for those who don’t improve with standard treatments. One promising avenue involves addressing sleep problems, which frequently occur alongside depression and may actually contribute to it.

The Sleep-Depression Connection

During healthy sleep, your brain cycles through different stages, including deep “slow wave sleep.” This stage is crucial for memory consolidation, emotional processing, and clearing waste products from the brain. It’s characterized by slow, synchronized electrical waves that can be measured with EEG recordings.

People with depression often show disrupted sleep patterns, particularly reduced slow wave sleep early in the night. This disruption may both reflect and contribute to depression symptoms. Interestingly, many effective antidepressant treatments seem to increase slow wave sleep as patients improve.

The Propofol Possibility

Propofol, commonly used for anesthesia during surgery, produces brain wave patterns that closely resemble natural slow wave sleep. Some patients report feeling unusually refreshed after propofol anesthesia, and early research suggests it might have mood-lifting properties.

This raises an intriguing possibility: Could carefully administered propofol help restore healthy sleep patterns in depressed patients? A small pilot study showed promising results in one patient who experienced both improved sleep and mood after propofol treatments.

The SWIPED Trial

The Slow Wave Induction by Propofol to Eliminate Depression (SWIPED) trial aims to test this idea systematically. Fifteen older adults with treatment-resistant depression will receive two propofol infusions, spaced 2-6 days apart. Using advanced EEG monitoring, doctors will adjust the propofol dose to maximize slow wave activity without going too deep.

Participants will wear special sleep-monitoring headbands at home before and after the treatments to track changes in their sleep patterns. They’ll also complete regular assessments of mood, thinking ability, and other symptoms for up to 10 weeks afterward.

What This Means for You

While this is an early-stage trial focused on safety and feasibility, it represents an innovative approach to treating depression. If successful, it could lead to new treatment options for people who haven’t responded to standard antidepressants.

The study also highlights the crucial role of sleep in mental health. Whether or not propofol proves effective, the research underscores the importance of addressing sleep problems as part of depression treatment. If you’re struggling with depression, discussing any sleep difficulties with your healthcare provider could be an important step toward improvement.

Conclusions

• This novel approach targets sleep disruption as a core feature of depression rather than just focusing on neurotransmitters
• The trial will help determine if propofol can safely enhance slow wave sleep in depressed older adults
• Results could lead to new treatment strategies combining sleep enhancement with standard antidepressants