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Comparison of efficacy of ketamine versus thiopentone-assisted modified electroconvulsive therapy in major depression

Amit Jagtiani, H. Khurana, N. Malhotra

Indian Journal of Psychiatry May 1, 2019 DOI: 10.4103/psychiatry.indianjpsychiatry_386_18 (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Randomized controlled trial Peer reviewed
Sample size 60
Population Hospitalized patients aged 18–45 with major depressive disorder
Topics Depression Esketamine Ketamine
Citations 15
Key findings Ketamine anesthesia during modified ECT led to faster recovery from depressive symptoms and required fewer sessions than thiopentone anesthesia.

Abstract

Background: It is well known that depression improves faster with electroconvulsive treatment (ECT) than with antidepressant medications. N-methyl-D-aspartate-receptor antagonists (ketamine) have been shown to have rapid antidepressant effects when given as an intravenous infusion. Faster recovery with ECT is likely when used with ketamine as anesthetic.

Aim: The aim of the study is to compare the outcome of modified electroconvulsive therapy (MECT) in major depressive disorder patients undergoing MECT with ketamine versus thiopentone anesthesia.

Materials and Methods: Sixty hospitalized patients (age: 18–45 years) with major depressive disorder (Diagnostic and Statistical Manual of Mental Disorders-IV Text Revision) were randomly allocated to either of the two MECT groups (30 patients each) receiving ketamine or thiopentone as anesthetic agent. The participants were assessed on a weekly basis on Hamilton Rating Scale for Depression (HAM-D) and Beck Depression Inventory (BDI).

Results: Ketamine group required significantly lesser number of MECT sessions for achieving remission and had rapid improvement in HAM-D and BDI scores compared to the thiopentone group. Furthermore, the stimulus intensity required to elicit seizures was significantly less and seizure duration was longer in ketamine group compared to the thiopentone group.

Conclusion: The use of ketamine for anesthesia led to rapid recovery from depressive symptoms and seems to be a better option for depressive patients, especially when a rapid response is desired.

Comparable studies

Other randomized controlled trials on ketamine for depression, most cited first.

Study Year Design Participants
Antidepressant Efficacy of Ketamine in Treatment-Resistant Major Depression: A Two-Site Randomized Controlled Trial Patients with treatment-resistant major depression experiencing a major depressive episode 2013 Randomized controlled trial n = 73
Efficacy and Safety of Flexibly Dosed Esketamine Nasal Spray Combined With a Newly Initiated Oral Antidepressant in Treatment-Resistant Depression: A Randomized Double-Blind Active-Controlled Study Adults with moderate to severe nonpsychotic depression and a history of nonresponse to... 2019 Phase 3, double-blind, active-controlled, multicenter randomized controlled trial n = 227
Efficacy of Esketamine Nasal Spray Plus Oral Antidepressant Treatment for Relapse Prevention in Patients With Treatment-Resistant Depression Adults with treatment-resistant depression who achieved stable remission or stable... 2019 Phase 3, multicenter, double-blind, randomized withdrawal study n = 297
Efficacy and Safety of Intranasal Esketamine Adjunctive to Oral Antidepressant Therapy in Treatment-Resistant Depression Adults with DSM-IV-TR diagnosis of major depressive disorder and history of inadequate... 2017 Phase 2, double-blind, doubly randomized, delayed-start, placebo-controlled study n = 67
Efficacy and Safety of Intranasal Esketamine for the Rapid Reduction of Symptoms of Depression and Suicidality in Patients at Imminent Risk for Suicide: Results of a Double-Blind, Randomized, Placebo-Controlled Study Depressed patients at imminent risk for suicide 2018 Randomized controlled trial n = 68

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