Abstract
ObjectiveWe investigated the clinical effects of the combination of ketamine and propofol as anesthetic agents during electroconvulsive therapy (ECT) in patients with uni- or bipolar major depressive episodes. We hypothesized that ketamine may confer short- and long- term advantages in improving depressive symptoms at the early stages of ECT.MethodsIn a randomized placebo-controlled trial, remission rates after 4 and 8 weeks of ECT were compared between patients who were randomly allocated to receive either the combination of ketamine (0.5 mg/kg) + propofol (n= 11) or placebo + propofol (n = 16). Depressive symptoms were assessed weekly using the Montgomery–Åsberg Depression Rating Scale (MADRS); ECT sessions were administered twice per week for a maximum of 8 weeks (16 sessions).ResultsAfter 4 weeks, we observed significantly fewer remitters (MADRS score < 10) in the ketamine + propofol group (0/11; 0%) than in the placebo + propofol group (5/16; 31%; χ2 = 4.22; p = 0.040). No significant difference was observed between the two groups regarding the number of patients who achieved remission weekly throughout the study period (Chi² = 3.588; p = 0.058). The mean duration of seizures was significantly shorter in the ketamine + propofol group than in the placebo + propofol group.ConclusionsThe results from the current study corroborated results from previously published studies and did not support the use of the combination of ketamine + propofol as an anesthetic agent for ECT in patients with major depressive episodes in clinical settings.
Highlights
Depression is one of the most disabling psychiatric conditions, and it had a very high worldwide prevalence (WHO, 2017)
We present the results from the Ketamine for electroconvulsive therapy (ECT): Optimization Strategy (KEOpS) study, a randomized double blind placebo-controlled study where we compared the remission rate after 8 and after 16 ECT sessions between patients who received the combination of low dose ketamine + propofol and patients who received propofol combined with placebo
We compared the number of remitters at week 4
Summary
Depression is one of the most disabling psychiatric conditions, and it had a very high worldwide prevalence (WHO, 2017). In the case of severe and/or treatment-resistant major depressive episodes (MDEs), electroconvulsive therapy (ECT) is commonly proposed as a therapeutic solution In such cases, ECT has been reported to be a highly effective intervention with a response rate estimated at more than 74% (Bahji et al, 2019) and a remission rate above 50% (Dierckx et al, 2012). In a meta-analysis of randomized controlled trials, McGirr and colleagues (2017) concluded that the use of ketamine in the ECT setting was not associated with greater improvements in depressive symptoms, higher rates of clinical response, higher rates of remission, or procognitive effects. Recent meta-analyses (Ren et al, 2018; Zheng et al, 2019) concluded that ketamine alone did not appear to improve the efficacy of ECT, ketamine in combination with other anesthetic agents may confer shortterm advantages in improving depressive symptoms at the early stages of ECT
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