Ketamine and Electroconvulsive Therapy: Better Together?
European Psychiatry June 1, 2022 A. Fraga, B. Mesquita, João Facucho-Oliveira et al.
A narrative review examined whether ketamine, a dissociative anesthetic, could improve the antidepressant effects of electroconvulsive therapy (ECT) for treatment-resistant depression. ECT is a standard end-line therapy but can cause memory impairment, possibly from overstimulation of glutamate receptors in the hippocampus. Ketamine blocks NMDA receptors and stimulates glutamate release, so it was proposed as an ECT adjuvant to reduce cognitive side effects and speed response. However, response and remission rates with ketamine in ECT showed no significant difference from comparator groups, and it was linked to more psychiatric and cardiovascular adverse events. The findings do not support combining ketamine and propofol as anesthetics for ECT in major depressive disorder.