S -ketamine compared to etomidate during electroconvulsive therapy in major depression

Area of Science:

• Neuroscience
• Psychiatry
• Anesthesiology

Background:

• Electroconvulsive therapy (ECT) is a vital treatment for severe or treatment-resistant major depressive disorder.
• Anesthetic agents play a crucial role in modulating ECT efficacy and safety.
• S-ketamine and etomidate are commonly used anesthetics in clinical practice, with distinct pharmacological profiles.

Purpose of the Study:

• To compare the effects of S-ketamine versus etomidate on seizure characteristics during ECT.
• To evaluate the safety aspects and clinical outcomes associated with each anesthetic agent in ECT.
• To determine the potential of S-ketamine as a favorable anesthetic for ECT in major depression.

Main Methods:

• Retrospective analysis of treatment data from 60 patients with major depressive disorder undergoing ECT.
• Patients received either S-ketamine (n=31) or etomidate (n=29) for anesthesia during right unilateral brief pulse ECT.
• Seizure characteristics (e.g., seizure threshold, stimulation charge, postictal suppression), adverse events, and clinical global impression (CGI) scores were compared between groups.

Main Results:

• S-ketamine group exhibited a lower initial seizure threshold, reduced stimulation charge, and increased postictal suppression compared to etomidate.
• EEG ictal amplitude, coherence, and maximum heart rate were significantly higher in the S-ketamine group.
• Etomidate was associated with a higher incidence of abortive seizures and required more restimulations; however, CGI scores and adverse event rates did not differ significantly between groups.

Conclusions:

• S-ketamine's lower seizure threshold suggests potential clinical advantages for ECT, warranting further investigation.
• While S-ketamine demonstrated specific electrophysiological and cardiovascular differences, overall clinical outcomes and adverse event profiles were comparable to etomidate.
• Further prospective randomized trials are necessary to confirm these findings and fully elucidate the safety and efficacy of S-ketamine in ECT, particularly regarding cardiovascular risks.