Comparison of efficacy of ketamine versus thiopentone-assisted modified electroconvulsive therapy in major depression

Depression improves faster with electroconvulsive treatment (ECT) than with antidepressant medications. Ketamine, an N-methyl-D-aspartate-receptor antagonist, has rapid antidepressant effects when given intravenously. In a randomized trial of 60 hospitalized patients aged 18–45 with major depressive disorder, those receiving ketamine as anesthesia during modified ECT required significantly fewer sessions to achieve remission and showed faster improvement on depression rating scales compared to those receiving thiopentone anesthesia. The ketamine group also needed lower stimulus intensity and had longer seizure duration. Ketamine anesthesia appears to be a better option when rapid response to ECT is desired.

Study at a glance

Abstract

Background: It is well known that depression improves faster with electroconvulsive treatment (ECT) than with antidepressant medications. N-methyl-D-aspartate-receptor antagonists (ketamine) have been shown to have rapid antidepressant effects when given as an intravenous infusion. Faster recovery with ECT is likely when used with ketamine as anesthetic. Aim: The aim of the study is to compare the outcome of modified electroconvulsive therapy (MECT) in major depressive disorder patients undergoing MECT with ketamine versus thiopentone anesthesia. Materials and Methods: Sixty hospitalized patients (age: 18–45 years) with major depressive disorder (Diagnostic and Statistical Manual of Mental Disorders-IV Text Revision) were randomly allocated to either of the two MECT groups (30 patients each) receiving ketamine or thiopentone as anesthetic agent. The participants were assessed on a weekly basis on Hamilton Rating Scale for Depression (HAM-D) and Beck Depression Inventory (BDI). Results: Ketamine group required significantly lesser number of MECT sessions for achieving remission and had rapid improvement in HAM-D and BDI scores compared to the thiopentone group. Furthermore, the stimulus intensity required to elicit seizures was significantly less and seizure duration was longer in ketamine group compared to the thiopentone group. Conclusion: The use of ketamine for anesthesia led to rapid recovery from depressive symptoms and seems to be a better option for depressive patients, especially when a rapid response is desired.