Depression Scores before and after Electrocompulsive Therapy with Propofol versus Ketamine Anesthesia: A Prospective Observational Study
Noor Zuhair Alsari, Nawfal Ali Mubarak, A. Al-Sabbagh
Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) August 5, 2025 DOI: 10.54133/ajms.v9i1.2063 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Prospective observational study Peer reviewed |
|---|---|
| Sample size | 50 |
| Population | Patients with treatment-resistant depression undergoing ECT |
| Interventions | Ketamine Propofol |
| Duration | Follow-up at 1 week, 1 month, and 3 months post-treatment |
| Measures | HDRS |
| Topics | Depression Esketamine Ketamine |
| Key findings | Ketamine-based anesthesia was associated with greater HDRS reductions at 1 week, 1 month, and 3 months after ECT, fewer relapses, and less need for additional ECT sessions compared with propofol-based anesthesia, but with higher blood pressure. The authors call for further studies to confirm these findings. |
Abstract
Background: Major depressive disorder (MDD) is a severe condition marked by persistent sadness and functional impairment. While electrocompulsive therapy (ECT) is effective for treatment-resistant cases, the comparative effects of propofol and ketamine as anesthetic agents remain unclear.
Objective: To compare the effects of propofol and ketamine anesthesia on depression severity in patients undergoing ECT using HDRS scores at multiple time points.
Methods: In this prospective observational study, 50 patients with treatment-resistant depression were assigned to receive ECT with either propofol- or ketamine-based anesthesia. Depression severity was measured using HDRS at baseline and 1 week, 1 month, and 3 months post-treatment. Secondary outcomes included relapse rates and additional ECT sessions.
Results: Patients receiving ketamine showed significantly greater HDRS reductions at all follow-ups (p<0.05), fewer relapses, and less need for additional ECT sessions compared with those receiving propofol. However, ketamine was associated with higher blood pressure.
Conclusions: Ketamine was associated with more robust and sustained improvement in depression scores following ECT than propofol. Further studies are needed to confirm these findings and to investigate other anesthetic options.
Comparable studies
Other observational and cohort studies on ketamine for depression, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Concomitant BDNF and sleep slow wave changes indicate ketamine-induced plasticity in major depressive disorder Patients with treatment-resistant major depressive disorder | 2012 | Observational cohort | n = 30 |
| Altered peripheral immune profiles in treatment-resistant depression: response to ketamine and prediction of treatment outcome Healthy controls and actively depressed patients with treatment-resistant depression... | 2017 | Observational cohort | n = 59 |
| Clinical Predictors of Ketamine Response in Treatment-Resistant Major Depression Treatment-resistant inpatients with DSM-IV-TR-diagnosed major depressive disorder or... | 2014 | Post hoc analysis of pooled data from four studies | n = 108 |
| An investigation of amino-acid neurotransmitters as potential predictors of clinical improvement to ketamine in depression Drug-free patients with major depressive disorder | 2011 | Observational cohort | n = 14 |
| Efficacy of ketamine therapy in the treatment of depression Drug-free/naïve men with severe depression, no history of psychotic disorder, head... | 2019 | Observational cohort | n = 25 |