Ketamine Augmentation of Electroconvulsive Therapy: A Scoping Review of Dose-Dependent Effects in Major Depressive Disorder.
Tarika Nagi, Amit Jagtiani, Saurabh Somvanshi, Satesh A Seegobin, Jasbir Singh, Anil K Bachu, Meenal Pathak
Cureus June 2023 DOI: 10.7759/cureus.40087 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Scoping review Randomized Peer reviewed |
|---|---|
| Intervention | Ketamine |
| Dose | low dose (<0.8 mg/kg) versus high dose (≥0.8 mg/kg) |
| Topics | Depression Esketamine Ketamine |
| Keywords | Depression ketamine Ect anesthesia Electroconvulsive therapy ect I.v. ketamine Iv ketamine Ketamine anesthesia Ketamine with ect Refractory depression |
| Key findings | Across 15 randomized controlled trials, the evidence on whether ketamine dose during ECT for major depression influences treatment response was inconsistent in both the speed and magnitude of response. The authors attribute this inconsistency partly to the absence of head-to-head dose comparisons and to methodological differences among studies, and conclude that a large randomized controlled trial is still needed. |
Abstract
Intravenous ketamine infusions in subanesthetic doses have been shown to rapidly alleviate depressive symptoms. However, the efficacy of ketamine as an anesthetic during electroconvulsive therapy (ECT) for major depression has not yet been answered by a large randomized control trial (RCT). This scoping review aims to examine the available literature to determine whether the dose of ketamine used during ECT influences the response to treatment. A literature search was conducted on PubMed to identify all published RCTs within the last 10 years which compared ketamine anesthesia during ECT for major depression with another anesthetic. Studies using low (<0.8 mg/kg) versus high (≥0.8 mg/kg) doses of ketamine during ECT were evaluated for the differences in outcomes using depression rating scales. Studies that examined ketamine as a standalone treatment for depression or focused primarily on the anesthetic benefits of ketamine were excluded from our review. Fifteen studies were utilized for this literature review. Overall, the studies showed inconsistent results in terms of the speed and magnitude of response to ketamine-assisted ECT in patients with major depression. Limitations of the available literature are discussed, including the lack of head-to-head comparisons, differences in methodology, inclusion/exclusion criteria, and primary and secondary endpoints.
Comparable studies
Other narrative reviews on ketamine for depression, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation Adults with treatment-resistant depression | 2021 | Review | |
| Ketamine: a paradigm shift for depression research and treatment | 2019 | Review | |
| Rapid‐acting antidepressant ketamine, its metabolites and other candidates: A historical overview and future perspective | 2019 | Review | |
| Ketamine: A tale of two enantiomers | 2020 | Review | |
| Molecular mechanisms underlying the antidepressant actions of arketamine: beyond the NMDA receptor | 2021 | Review |