Summary: Researchers report there is no added benefit in using ketamine over standard anesthetic when it comes to administering ECT to people with depression.
Source: University of Aberdeen.
There is no added benefit to using ketamine over a standard anaesthetic during electroconvulsive therapy (ECT) according to new research from the University of Aberdeen.
The study published in the British Journal of Psychiatry this week found that patients receiving ECT received no additional benefit if they were anaesthetised using ketamine as opposed to the more commonly used anaesthetic, propofol.
The trial compared the use of ketamine as an anaesthetic during ECT against a more commonly used anaesthetic to see if it improves the symptoms of depression sooner.
Ketamine is increasingly being used as a possible treatment for depression and recently there has been interest in its use in combination with ECT
In the study, patients already being treated for depression and referred for ECT were anaesthetised with either ketamine or the traditional anaesthetic, propofol, but no additional benefit was found in those given ketamine.
Specifically, ketamine provided no advantage for reducing depression severity, number of subsequent ECT treatments required or in preserving cognitive performance.
Dr Gordon Fernie who worked on the trial said: “Electroconvulsive therapy is a highly effective treatment for severe depression, but factors including side effect profile, the necessity for extended hospital care, and stigma, restrict its use.
“Accumulating interest in the use of ketamine as an acute treatment for severe depression and as the anaesthetic for ECT suggests that using ketamine could mitigate these factors. However, evidence is equivocal. In this controlled trial, we present results comparing ketamine with propofol anaesthesia for ECT.
“Now our results add to evidence that suggests ketamine during ECT is no more effective than propofol at alleviating depressive symptoms despite its promise when given in smaller, sub-anaesthetic doses.
“This trial was the final piece of research conducted by Professor Ian Reid before his untimely death in 2014 cut short his psychiatric and research career investigating ECT and the treatment of depression.”
Funding: C.AS. reports grants from Vifor Pharma, outside the submitted work. I.C.R. (deceased) declared personal fees from AstraZeneca, Sanofi Aventis and Sunovion, and non-financial support from Lundbeck, between 2009 and 2014 and all outside the submitted work.
Source: Simon Wood – University of Aberdeen
Image Source: NeuroscienceNews.com image is in the public domain.
Original Research: Abstract for “Ketamine as the anaesthetic for electroconvulsive therapy: the KANECT randomised controlled trial” by Gordon Fernie, James Currie, Jennifer S. Perrin, Caroline A. Stewart, Virginica Anderson, Daniel M. Bennett, Steven Hay, and Ian C. Reid in British Journal of Psychiatry. Published online March 2017 doi:10.1192/bjp.bp.116.189134
Ketamine as the anaesthetic for electroconvulsive therapy: the KANECT randomised controlled trial
Ketamine has recently become an agent of interest as an acute treatment for severe depression and as the anaesthetic for electroconvulsive therapy (ECT). Subanaesthetic doses result in an acute reduction in depression severity while evidence is equivocal for this antidepressant effect with anaesthetic or adjuvant doses. Recent systematic reviews call for high-quality evidence from further randomised controlled trials (RCTs).
To establish if ketamine as the anaesthetic for ECT results in fewer ECT treatments, improvements in depression severity ratings and less memory impairment than the standard anaesthetic.
Double-blind, parallel-design, RCT of intravenous ketamine (up to 2 mg/kg) with an active comparator, intravenous propofol (up to 2.5 mg/kg), as the anaesthetic for ECT in patients receiving ECT for major depression on an informal basis. (Trial registration: European Clinical Trials Database (EudraCT): 2011-000396-14 and clinicalTrials.gov: NCT01306760.)
No significant differences were found on any outcome measure during, at the end of or 1 month following the ECT course.
Ketamine as an anaesthetic does not enhance the efficacy of ECT.
“Ketamine as the anaesthetic for electroconvulsive therapy: the KANECT randomised controlled trial” by Gordon Fernie, James Currie, Jennifer S. Perrin, Caroline A. Stewart, Virginica Anderson, Daniel M. Bennett, Steven Hay, and Ian C. Reid in British Journal of Psychiatry. Published online March 2017 doi:10.1192/bjp.bp.116.189134