Ketamine in electroconvulsive therapy for depressive disorder: A systematic review and meta-analysis.
Li Ren, Jie Deng, S. Min, Lihua Peng, Qibin Chen
Journal of Psychiatric Research September 1, 2018 DOI: 10.1016/j.jpsychires.2018.07.003 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review and meta-analysis Randomized Peer reviewed |
|---|---|
| Sample size | 928 |
| Population | Patients with depressive disorder receiving electroconvulsive therapy |
| Intervention | Ketamine |
| Topics | Depression Esketamine Ketamine |
| Citations | 48 |
| Key findings | Ketamine used in ECT did not reduce depressive symptoms at the end of treatment but accelerated antidepressant effects during the ECT course, especially as an add-on anesthetic, while increasing adverse events. |
Abstract
Electroconvulsive therapy (ECT) is one of the most effective treatments for depressive disorder. Sub-anesthetic dose of ketamine exerts a rapid and robust antidepressive effect. However, it is still unclear whether ketamine usage in ECT is efficacious as an antidepressant. We aimed to conduct a systematic review and meta-analysis on the effects of ketamine in ECT among patients with depressive disorder. MEDLINE, EMBASE, the CENTRAL and PsycINFO for randomized controlled trials were searched to assess the effects of ketamine used in ECT until 31 Mar 2018 (PROSPERO: CRD42018081024). Sixteen studies including 928 patients were enrolled. At the end of ECT, no significant standardized mean difference (SMD) was observed in favor of the ketamine group. Depressive scores were lower in the ketamine group after 1st ECT and 3rd to 6th ECTs. The depressive scores were lower after 2nd, 3rd, 4th and 6th ECTs when the ketamine was used as an add-on anesthetic, while the depressive scores were lower after 1st ECT when ketamine alone was used. Ketamine in ECT showed no better response and remission rate, while increased adverse events, especially related to cardiovascular and psychiatric systems, during the whole ECT course. In conclusion, although ketamine used in ECT cannot reduce the depressive symptoms at the end of treatment, it could accelerate the antidepressive effect in depressive patients receiving ECT, especially in those who used ketamine as an add-on anesthetic. However, ketamine cautiously needs to be administered in ECT due to the possibility of increased risk of side effects.
Comparable studies
Other systematic reviews and meta-analyses on ketamine for depression, most cited first.
Citations in the library
Cited by 14
- Ketamine and depression: a narrative review Drug Design, Development and Therapy August 1, 2019
- The Canadian Network for Mood and Anxiety Treatments (CANMAT) Task Force Recommendations for the Use of Racemic Ketamine in Adults with Major Depressive Disorder: Recommandations Du Groupe De Travail Du Réseau Canadien Pour Les Traitements De L’humeur Et De L’anxiété (Canmat) Concernant L’utilisation De La Kétamine Racémique Chez Les Adultes Souffrant De Trouble Dépressif Majeur The Canadian Journal of Psychiatry November 11, 2020
- Intermittent administration of low dose ketamine can shorten the course of electroconvulsive therapy for depression and reduce complications: A randomized controlled trial. Psychiatry Research November 1, 2019
- Comparison of efficacy of ketamine versus thiopentone-assisted modified electroconvulsive therapy in major depression Indian Journal of Psychiatry May 1, 2019
- Effects of ketamine in electroconvulsive therapy for major depressive disorder: meta-analysis of randomised controlled trials General Psychiatry June 18, 2020
and 9 more in the library
Cites 14
- A Randomized Trial of an N-methyl-D-aspartate Antagonist in Treatment-Resistant Major Depression Archives of General Psychiatry August 1, 2006
- Antidepressant Efficacy of Ketamine in Treatment-Resistant Major Depression: A Two-Site Randomized Controlled Trial American Journal of Psychiatry August 28, 2013
- Mechanisms of Ketamine Action as an Antidepressant Molecular Psychiatry March 13, 2018
- Side-effects associated with ketamine use in depression: a systematic review. The Lancet Psychiatry 2018
- A Double-Blind, Randomized, Placebo-Controlled, Dose-Frequency Study of Intravenous Ketamine in Patients With Treatment-Resistant Depression American Journal of Psychiatry April 8, 2016
and 9 more in the library