Ketamine and Electroconvulsive Therapy

Abstract

There is interest in giving ketamine during anaesthesia for electroconvulsive therapy (ECT) to enhance efficacy and block cognitive side effects associated with ECT. A number of randomised controlled trials and other studies have compared ECT outcomes when ketamine (as sole or adjunctive anaesthetic) or other anaesthetic agents are used. The body of evidence to date suggests that adding ketamine to ECT results in a faster onset of antidepressant response (similar to results seen with ketamine alone, without ECT) but does not result in greater efficacy by the end of the ECT course. Results are inconclusive regarding whether ketamine reduces the cognitive side effects of ECT. Adverse effects associated with the use of ketamine include raised blood pressure, psychotomimetic side effects (though these appear less problematic in the context of ECT treatment) and—when ketamine is given at higher doses—a longer time to post-procedure recovery. At present, the evidence does not support the routine use of ketamine for ECT, but ketamine may be useful for patients who require a rapid antidepressant response. The potential of combined ECT-ketamine treatment to increase efficacy in patients refractory to treatment with ECT alone (or ketamine alone) remains to be investigated.