Ketamine in electroconvulsive therapy for depressive disorder: A systematic review and meta-analysis.
Li Ren, Jie Deng, S. Min, Lihua Peng, Qibin Chen
Journal of Psychiatric Research September 1, 2018 DOI: 10.1016/j.jpsychires.2018.07.003 via Semantic Scholar
Summary
Electroconvulsive therapy (ECT) is highly effective for depression, and ketamine at sub-anesthetic doses also produces rapid antidepressant effects. This systematic review and meta-analysis of 16 randomized controlled trials involving 928 patients examined whether adding ketamine to ECT improves outcomes. At the end of the ECT course, depressive symptoms were not significantly lower in the ketamine group compared to controls. However, depressive scores were lower after the first and after the third through sixth ECT sessions, particularly when ketamine was used as an add-on anesthetic. Ketamine did not improve overall response or remission rates and increased adverse events, especially cardiovascular and psychiatric side effects. Ketamine may accelerate antidepressant effects during ECT but should be used cautiously due to added risks.
Study at a glance
| Characteristics | Systematic review and meta-analysis Randomized Peer reviewed |
|---|---|
| Sample size | 928 |
| Population | Patients with depressive disorder receiving electroconvulsive therapy |
| Keywords | Medicine |
| Citations | 48 |
| Key finding | Ketamine used in ECT did not reduce depressive symptoms at the end of treatment but accelerated antidepressant effects during the ECT course, especially as an add-on anesthetic, while increasing adverse events. |
Abstract
Electroconvulsive therapy (ECT) is one of the most effective treatments for depressive disorder. Sub-anesthetic dose of ketamine exerts a rapid and robust antidepressive effect. However, it is still unclear whether ketamine usage in ECT is efficacious as an antidepressant. We aimed to conduct a systematic review and meta-analysis on the effects of ketamine in ECT among patients with depressive disorder. MEDLINE, EMBASE, the CENTRAL and PsycINFO for randomized controlled trials were searched to assess the effects of ketamine used in ECT until 31 Mar 2018 (PROSPERO: CRD42018081024). Sixteen studies including 928 patients were enrolled. At the end of ECT, no significant standardized mean difference (SMD) was observed in favor of the ketamine group. Depressive scores were lower in the ketamine group after 1st ECT and 3rd to 6th ECTs. The depressive scores were lower after 2nd, 3rd, 4th and 6th ECTs when the ketamine was used as an add-on anesthetic, while the depressive scores were lower after 1st ECT when ketamine alone was used. Ketamine in ECT showed no better response and remission rate, while increased adverse events, especially related to cardiovascular and psychiatric systems, during the whole ECT course. In conclusion, although ketamine used in ECT cannot reduce the depressive symptoms at the end of treatment, it could accelerate the antidepressive effect in depressive patients receiving ECT, especially in those who used ketamine as an add-on anesthetic. However, ketamine cautiously needs to be administered in ECT due to the possibility of increased risk of side effects.