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Ketamine-based anesthesia improves electroconvulsive therapy outcomes: a randomized-controlled study.

Jonathan J Gamble1, Henry Bi2, Rudy Bowen3

  • 1Department of Anesthesia, Perioperative Medicine, and Pain Management, University of Saskatchewan, Royal University Hospital, 103 Hospital Dr, Saskatoon, SK, S7N 0W8, Canada. J_Gamble@yahoo.com.

Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|April 28, 2018
PubMed
Summary
This summary is machine-generated.

Ketamine anesthesia for electroconvulsive therapy (ECT) significantly improved outcomes for treatment-resistant major depressive disorder (MDD) compared to propofol. Patients receiving ketamine required fewer ECT sessions for symptom reduction and remission.

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Area of Science:

  • Neuroscience
  • Psychiatry
  • Anesthesiology

Background:

  • Major depressive disorder (MDD) is a prevalent and challenging condition.
  • Electroconvulsive therapy (ECT) is the established treatment for treatment-resistant MDD.
  • Anesthesia choice for ECT may impact treatment efficacy.

Purpose of the Study:

  • To compare the efficacy of ketamine-based versus propofol-based anesthesia during ECT for treatment-resistant MDD.
  • To determine if ketamine anesthesia leads to faster symptom improvement and remission.

Main Methods:

  • A randomized clinical trial comparing ketamine and propofol anesthesia in patients with treatment-resistant MDD undergoing ECT.
  • Modified intention-to-treat analysis assessing the number of ECT treatments for 50% Montgomery-Asberg Depression Rating Scale (MADRS) reduction and remission (MADRS ≤ 10).

Main Results:

  • The study was terminated early due to significant findings after interim analysis.
  • All patients (100%) receiving ketamine achieved ≥50% MADRS reduction after a median of 2 ECT treatments, versus 83% of propofol patients after 4 treatments.
  • Remission (MADRS ≤ 10) was achieved by all ketamine patients versus 58% of propofol patients.
  • Time to response and remission significantly differed between groups, with similar adverse events and recovery times.

Conclusions:

  • Ketamine-based anesthesia for ECT is superior to propofol for improving outcomes in treatment-resistant MDD.
  • Ketamine facilitates faster response and remission with fewer ECT sessions.
  • Further research into ketamine's role in ECT for MDD is warranted.