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Mood and neuropsychological effects of different doses of ketamine in electroconvulsive therapy for treatment-resistant depression.
- Source :
-
Journal of affective disorders [J Affect Disord] 2016 Sep 01; Vol. 201, pp. 124-30. Date of Electronic Publication: 2016 May 12. - Publication Year :
- 2016
-
Abstract
- Background: Treatment-resistant depression (TRD) is a growing clinical challenge. Electroconvulsive therapy (ECT) is an effective tool for TRD treatment. However, there remains a subset of patients who do not respond to this treatment with common anesthetic agent. Ketamine, a noteworthy anesthetic agent, has emerged as an augmentation to enhance the antidepressant efficacy of ECT. Trials of i.v. ketamine in TRD indicated dose-related mood enhancing efficacy. We aimed to explore anesthetic and subanesthetic concentrations of ketamine in ECT for TRD with respect to their impact on mood and neuropsychological effects.<br />Methods: Ninety TRD patients (36 males, 54 females; average age, 30.6 years old) were randomly assigned to receive either ketamine (0.8mg/kg) (n=30), subanesthetic ketamine (0.5mg/kg) plus propofol (0.5mg/kg) (n=30) or propofol (0.8mg/kg) (n=30) as an anesthetic and underwent 8 ECT sessions. The primary outcome measures were the 17-item Hamilton Depression Rating Scale (HDRS-17), cognitive assessments and seizure parameters.<br />Results: The ketamine group had an earlier improvement in HDRS-17, longer seizure duration, lower electric quantity, a higher remission rate, and a lower degree of executive cognitive impairment compared to the ketamine+propofol and propofol groups. The ketamine+propofol group showed earlier improvement in the HDRS-17, a longer seizure duration and a different seizure energy index when compared to the propofol group.<br />Limitations: The postoperative dissociative side effect was not assessed.<br />Conclusions: Both anesthetic and subanesthetic concentrations of ketamine have rapid mood enhancing actions in ECT for TRD, while anesthetic concentrations results in larger magnitudes of antidepression and cognitive protection. ECT with ketamine anesthesia might be an optimized therapy for patients with TRD.<br /> (Copyright © 2016 Elsevier B.V. All rights reserved.)
- Subjects :
- Adolescent
Adult
Affect physiology
Aged
Anesthetics, Intravenous administration & dosage
Combined Modality Therapy
Depressive Disorder, Treatment-Resistant physiopathology
Double-Blind Method
Drug Therapy, Combination
Female
Humans
Male
Middle Aged
Propofol administration & dosage
Psychiatric Status Rating Scales
Seizures
Treatment Outcome
Young Adult
Affect drug effects
Cognition Disorders physiopathology
Depressive Disorder physiopathology
Depressive Disorder, Treatment-Resistant therapy
Electroconvulsive Therapy methods
Excitatory Amino Acid Antagonists administration & dosage
Ketamine administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1573-2517
- Volume :
- 201
- Database :
- MEDLINE
- Journal :
- Journal of affective disorders
- Publication Type :
- Academic Journal
- Accession number :
- 27208499
- Full Text :
- https://doi.org/10.1016/j.jad.2016.05.011