Evaluating Ketamine vs Thiopental as an Anesthetic Adjuvant for Electroconvulsive Therapy for Treatment-Resistant Depression: A Meta-Analysis

Background: Treatment-resistant depression (TRD) poses a significant challenge, with electroconvulsive therapy (ECT) being its highly effective intervention. The choice of anesthetic agents may influence the treatment efficacy and outcomes. This meta-analysis compares ketamine and thiopental as anesthetic adjuvants during ECT in TRD patients.

Methods: A systematic review and meta-analysis were performed, including four studies with 320 participants selected from six databases. The included studies comprised three randomized controlled trials (RCTs) and one retrospective cohort study. Outcomes analyzed using RevMan 5.4, which included HDRS or HAM-D scores, seizure duration, cognitive outcomes, and adverse events. Data were assessed using a random-effects model, with heterogeneity evaluated via the I 2 statistic.

Results: Both ketamine and thiopental significantly reduced depressive symptoms (ketamine: MD 22.19, 95% CI [16.99, 27.40], P < 0.001; thiopental: MD 20.24, 95% CI [14.07, 26.41], P < 0.001). No significant differences were observed in their efficacy for symptom reduction (SMD −0.43, 95% CI [−0.99, 0.12], P = 0.12) or seizure duration (SMD 0.28, 95% CI [−0.50, 1.06], P = 0.48). Ketamine showed longer EEG seizure durations, indicating potential enhancement of ECT effectiveness, but it was associated with higher rates of nausea, transient delirium, and hypertension. Thiopental had a more favorable safety profile for patients with cardiovascular comorbidities. Cognitive outcomes varied, with mixed findings across studies. Significant heterogeneity was observed.

Conclusion: Both ketamine and thiopental are equally effective as ECT adjuvants in TRD patients. Further research with larger sample sizes, standardized protocols, and subgroup analyses is needed to confirm its superiority and address the heterogeneity.