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Adjunctive ketamine in electroconvulsive therapy: updated systematic review and meta-analysis
Alexander McGirr1, Marcelo T Berlim2, David J Bond2
1Alexander McGirr, MD, MSc, Department of Psychiatry, University of British Columbia, Vancouver; Marcelo T. Berlim, MD, MSc, Neuromodulation Research Clinic, Depressive Disorders Program, Douglas Mental Health University Institute and McGill University, Montréal, Québec, Canada; David J. Bond, MD, PhD, Department of Psychiatry, University of Minnesota, Minneapolis, USA; Peter Y. Chan, MD, Department of Psychiatry, University of British Columbia, and Neurostimulation Service, Vancouver General Hospital, Vancouver; Lakshmi N. Yatham, MBBS, Raymond W. Lam, MD, Department of Psychiatry and Mood Disorders Centre of Excellence, University of British Columbia, Vancouver, Canada alexander.mcgirr@alumni.ubc.ca.
Ketamine augmentation of electroconvulsive therapy (ECT) did not improve depressive symptoms or clinical response rates in a systematic review. This finding held true even when barbiturate anesthetics were not used, with increased confusion reported.
Area of Science:
- Neuroscience
- Psychiatry
- Pharmacology
Background:
- Ketamine shows promise for major depressive episodes.
- Interest is growing in ketamine's potential to enhance electroconvulsive therapy (ECT).
Purpose of the Study:
- To update a systematic review and meta-analysis on ketamine-augmented ECT.
- To test if barbiturate anesthetics explain ketamine's lack of efficacy in ECT.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs).
- Searched EMBASE, CENTRAL, and Medline for relevant trials.
- Synthesized data from ten trials (333 in ketamine group, 269 in comparator).
Main Results:
- Ketamine-augmented ECT did not improve depressive symptoms, clinical response, or remission rates.
- No pro-cognitive effects were observed with ketamine during ECT.
- Increased confusion was reported in patients receiving ketamine with ECT, regardless of anesthetic used.
Conclusions:
- Current evidence does not support using ketamine as an induction agent for ECT.
- Further research may be needed to clarify ketamine's role in ECT, if any.