Abstract
The aim of this study was to assess the efficacy and tolerability/acceptability of 6 anesthetic agents in ECT for depressive disorders. We systematically reviewed 14 double-blind randomized controlled trials (610 participants). Efficacy was measured by the mean scores on validated depression scales at 6 ECT (or the nearest score if not available), number of responders at the end of treatment and seizure duration. The acceptability was measured by the proportion of patients who dropped out of the allocated treatment, and the tolerability by the number of serious adverse events and post-treatment cognition assessment. After excluding the trials responsible for heterogeneity, depression scores of patients who were administered methohexital were found to be significantly more improved than those who received propofol (p = 0.001). On the contrary, those who were administered propofol had lower depression scores than those with thiopental at the end of treatment (p = 0.002). Compared to propofol, methohexital was found to be significantly associated with higher seizure duration (p = 0.018). No difference was found for the acceptability profile (all p > 0.05). In summary, ketamine and methohexital may be preferred to propofol or thiopental in regard of effectiveness in depression scores and increased seizure duration. Further studies are warranted to compare ketamine and methohexital.
Highlights
Effect on seizure duration during the course of Electroconvulsive therapy (ECT), which may result in more inadequate seizures, despite the use of a higher mean stimulus charge[6]
Fourteen randomized controlled trials (RCTs) were included in our quantitative meta-analysis, totaling 610 subjects with a major depressive episode (n = 545 with MDD; n = 65 with BD)
We identified 3 studies comparing the effect of METH administration (n = 86) to PROP (n = 78) on depression scores[29,32,33]
Summary
Effect on seizure duration during the course of ECT, which may result in more inadequate seizures, despite the use of a higher mean stimulus charge[6]. Ketamine was recently reported to have specific short-term antidepressive properties in both ECT and non-ECT studies[7,8]. It remains rarely used for anesthesia in clinical practice, due to potential side-effects, namely severe blood pressure increase, manic switches in bipolar patients, confusion and prolonged delirium[9,10,11,12]. The objective of the present systematic review and multiple-treatment meta-analysis, which accounts for both direct and indirect comparisons, was to assess effectiveness, acceptability and tolerability of 6 anesthetic agents used in ECT for major depression
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