Ketamine Anesthesia, Efficacy of Electroconvulsive Therapy, and Cognitive Functions in Treatment-Resistant Depression

Mar 24, 2016The journal of ECT

Ketamine Anesthesia, Electroconvulsive Therapy Success, and Thinking Skills in Hard-to-Treat Depression

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Abstract

The addition of ketamine anesthesia to electroconvulsive therapy (ECT) is associated with improved antidepressant efficacy in patients with drug-resistant depression.

Patients receiving ketamine during ECT had a significantly lower intensity of depression after treatment compared to those who received only thiopental anesthesia.
The mean depression intensity before ECT was 32 points on the Hamilton Depression Rating Scale, with no differences between groups prior to treatment.
Cognitive assessments indicated a more significant worsening in verbal memory for patients who had ketamine anesthesia added to their ECT sessions.
The average number of ECT sessions for participants was 10.8, with no differences observed between the treatment groups.

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OBJECTIVES: Electroconvulsive therapy (ECT) is the most effective treatment for drug-resistant depression (DRD). Because a single infusion of ketamine may exert both a rapid antidepressant effect and a quick improvement of cognition, the aim of the present study was to assess whether ketamine, as an anesthetic drug for ECT, can augment the antidepressant activity of the procedure and/or exert a beneficial effect on cognition.

METHODS: A total of 11 male and 34 female patients with DRD, aged 21 to 75 years, were included in the study. Fifteen patients (group 1) received only thiopental anesthesia, 15 patients (group 2) had their second and third ECT sessions with ketamine, and 15 patients (group 3) had ketamine for the second, fourth, sixth, eighth, and tenth sessions. Depression intensity was measured by the 17-item Hamilton Depression Rating Scale. Cognitive functions were measured before and after ECT, assessing visual-spatial abilities, verbal auditory memory, working memory, and executive functions.

RESULTS: Before the ECT, the mean (SD) intensity of depression was 32 (6) points on the Hamilton Depression Rating Scale and the mean number of ECT sessions was 10.8 (1.5), with no difference between groups. After the last ECT session, the intensity of depression was significantly lower in group 3, compared with group 1. Cognitive assessments after ECT showed a more marked worsening in verbal memory in patients with added ketamine anesthesia.

CONCLUSIONS: The addition of ketamine may be connected with better antidepressant efficacy of ECT, compared with only thiopental anesthesia. However, patients with added ketamine had worse results on some of the indices measuring verbal memory.

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Ketamine Anesthesia, Efficacy of Electroconvulsive Therapy, and Cognitive Functions in Treatment-Resistant Depression

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