Ketamine plus propofol-electroconvulsive therapy (ECT) transiently improves the antidepressant effects and the associated brain functional alterations in patients with propofol-ECT-resistant depression.
Jianjing Zhang, H. Tian, Jie Li, Shengzhang Ji, Suling Chen, Jingjing Zhu, Deguo Jiang, Lina Wang, Gongying Li, Min Chen, Wenqiang Wang, Xiaodong Lin, C. Zhuo
Psychiatry Research March 6, 2020 DOI: 10.1016/j.psychres.2020.112907 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Observational cohort Peer reviewed |
|---|---|
| Sample size | 28 |
| Population | Patients with propofol-electroconvulsive therapy-resistant depression |
| Interventions | Ketamine Propofol-ECT |
| Duration | Two-week intervention, 7-day clinical follow-up, 10-day functional connectivity follow-up |
| Topics | Depression Esketamine Ketamine |
| Citations | 13 |
| Key findings | Adding ketamine to propofol-ECT improves short-term therapeutic outcomes in ECT-resistant depression, but the clinical effect lasts only 7 days, while brain functional changes persist for 10 days. |
Abstract
New methods for using ketamine in patients with propofol-electroconvulsive therapy-resistant depression (ECT-RD) are needed in the clinic. This study aimed to investigate the therapeutic efficacy of ketamine plus ECT in ECT-RD patients, along with the treatment-induced brain alterations. A total of 28 ECT-RD patients were intravenously injected with ketamine six times and treated with propofol-ECT six times alternately within two weeks. The Hamilton Depression Scale was used to assess the treatment effect. Global functional connectivity density (gFCD) and functional connectivity strength (FCS) were used to evaluate functional brain alterations. As compared with the propofol-ECT treatment group, the addition of ketamine could improve the therapeutic outcomes in patients with ECT-RD. The treatment increased gFCD in the left temporal and subgenual anterior cingulated cortex. Simultaneously, the treatment decreased FCS within the default mode network. Although increased functional connectivity could be sustained for 10 days, the clinical effect was only sustained 7 days, indicating that the clinical effect and functional brain alterations were disjointed. Ketamine plus propofol-ECT can obviously improve the effects of propofol-ECT in ECT-RD patients. However, the effect is limited in 7 days, suggesting the benefit is short-term.