PMID- 29847468
OWN - NLM
STAT- MEDLINE
DCOM- 20181221
LR  - 20181221
IS  - 1537-1921 (Electronic)
IS  - 0898-4921 (Linking)
VI  - 30
IP  - 4
DP  - 2018 Oct
TI  - Ketamine Anesthesia Does Not Improve Depression Scores in Electroconvulsive 
      Therapy: A Randomized Clinical Trial.
PG  - 305-313
LID - 10.1097/ANA.0000000000000511 [doi]
AB  - BACKGROUND: Although interest in ketamine use during electroconvulsive therapy 
      (ECT) has increased, studies have been equivocal with regard to its efficacy. The 
      aims of this clinical trial were to evaluate ketamine's antidepressive effects in 
      ECT as a primary anesthetic, determine ketamine's tolerability when compared with 
      standard anesthesia, and determine if plasma brain-derived neurotrophic factor 
      (BDNF) is necessary for treatment response. MATERIALS AND METHODS: Adults meeting 
      criteria for treatment-resistant depression undergoing index course ECT received 
      either methohexital (1 to 2 mg/kg) or ketamine (1 to 2 mg/kg) anesthesia in this 
      dual-arm double-blinded randomized clinical trial (NCT02752724). The primary 
      outcome of this study is change in depression questionnaire scores before and 
      after ECT. Seizure data, depression severity using self-reported and 
      clinician-assessed questionnaires, cognitive scoring, and plasma BDNF 
      concentrations were obtained before and after completion of ECT. RESULTS: There 
      were no differences in seizure lengths, hemodynamics, or seizure stimuli between 
      the ketamine (n=23;138 ECTs) and methohexital (n=27;159 ECTs) groups. Depression 
      scores improved similarly after ECT in both groups. In the methohexital group, 
      15% of patients failed to achieve adequate seizures and were switched to ketamine 
      and 26% were converted to bilateral ECT stimulus, whereas all ketamine patients 
      achieved adequate seizures and only 4% required bilateral stimulus. Plasma BDNF 
      increased after ECT only in the ketamine group. CONCLUSIONS: Our data show that 
      ketamine does not significantly improve depression when compared with 
      methohexital as a single induction agent for ECT, increases serum BDNF and does 
      not increase rates of post-ECT agitation. Ketamine use in ECT may have some 
      benefits for some patients that are not captured through standard depression 
      assessment questionnaires alone.
FAU - Carspecken, Charles William
AU  - Carspecken CW
AD  - Departments of Anesthesiology and Pain Medicine.
FAU - Borisovskaya, Anna
AU  - Borisovskaya A
AD  - Psychiatry and Behavioral Sciences, VA Puget Sound Medical Center, University of 
      Washington, Seattle, WA.
FAU - Lan, Shu-Tsui
AU  - Lan ST
AD  - Departments of Anesthesiology and Pain Medicine.
FAU - Heller, Katherine
AU  - Heller K
AD  - Departments of Anesthesiology and Pain Medicine.
FAU - Buchholz, Jonathan
AU  - Buchholz J
AD  - Psychiatry and Behavioral Sciences, VA Puget Sound Medical Center, University of 
      Washington, Seattle, WA.
FAU - Ruskin, David
AU  - Ruskin D
AD  - Psychiatry and Behavioral Sciences, VA Puget Sound Medical Center, University of 
      Washington, Seattle, WA.
FAU - Rozet, Irene
AU  - Rozet I
AD  - Departments of Anesthesiology and Pain Medicine.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PL  - United States
TA  - J Neurosurg Anesthesiol
JT  - Journal of neurosurgical anesthesiology
JID - 8910749
RN  - 0 (Anesthetics, Dissociative)
RN  - 0 (Anesthetics, Intravenous)
RN  - 0 (Brain-Derived Neurotrophic Factor)
RN  - 690G0D6V8H (Ketamine)
RN  - 7171WSG8A2 (BDNF protein, human)
RN  - E5B8ND5IPE (Methohexital)
SB  - IM
CIN - J ECT. 2019 Sep;35(3):146-147. PMID: 30633070
MH  - Adult
MH  - Anesthesia/*psychology
MH  - *Anesthetics, Dissociative
MH  - Anesthetics, Intravenous
MH  - Brain-Derived Neurotrophic Factor/blood
MH  - Cognition
MH  - Depressive Disorder, Treatment-Resistant/psychology/*therapy
MH  - Double-Blind Method
MH  - Electroconvulsive Therapy/*methods
MH  - Female
MH  - Hemodynamics
MH  - Humans
MH  - *Ketamine
MH  - Male
MH  - Methohexital
MH  - Middle Aged
MH  - Psychiatric Status Rating Scales
MH  - Seizures/physiopathology
MH  - Treatment Outcome
EDAT- 2018/05/31 06:00
MHDA- 2018/12/24 06:00
CRDT- 2018/05/31 06:00
PHST- 2018/05/31 06:00 [pubmed]
PHST- 2018/12/24 06:00 [medline]
PHST- 2018/05/31 06:00 [entrez]
AID - 10.1097/ANA.0000000000000511 [doi]
PST - ppublish
SO  - J Neurosurg Anesthesiol. 2018 Oct;30(4):305-313. doi: 
      10.1097/ANA.0000000000000511.