TY - JOUR
T1 - Efficacy and safety of ketamine-assisted electroconvulsive therapy in major depressive episode
T2 - a systematic review and network meta-analysis
AU - Rhee, Taeho Greg
AU - Shim, Sung Ryul
AU - Popp, Jonah H.
AU - Trikalinos, Thomas A.
AU - Rosenheck, Robert A.
AU - Kellner, Charles H.
AU - Seiner, Stephen J.
AU - Espinoza, Randall T.
AU - Forester, Brent P.
AU - McIntyre, Roger S.
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to Springer Nature Limited 2023.
PY - 2024/3
Y1 - 2024/3
N2 - Objective: To meta-analyze clinical efficacy and safety of ketamine compared with other anesthetic agents in the course of electroconvulsive therapy (ECT) in major depressive episode (MDE). Methods: PubMed/MEDLINE, Cochrane Library, Embase, GoogleScholar, and US and European trial registries were searched from inception through May 23, 2023, with no language limits. We included RCTs with (1) a diagnosis of MDE; (2) ECT intervention with ketamine and/or other anesthetic agents; and (3) measures included: depressive symptoms, cognitive performance, remission or response rates, and serious adverse events. Network meta-analysis (NMA) was performed to compare ketamine and 7 other anesthetic agents. Hedges’ g standardized mean differences (SMDs) were used for continuous measures, and relative risks (RRs) were used for other binary outcomes using random-effects models. Results: Twenty-two studies were included in the systematic review. A total of 2322 patients from 17 RCTs were included in the NMA. The overall pooled SMD of ketamine, as compared with propofol as a reference group, was –2.21 (95% confidence interval [CI], –3.79 to –0.64) in depressive symptoms, indicating that ketamine had better antidepressant efficacy than propofol. In a sensitivity analysis, however, ketamine-treated patients had a worse outcome in cognitive performance than propofol-treated patients (SMD, –0.18; 95% CI, –0.28 to –0.09). No other statistically significant differences were found. Conclusions: Ketamine-assisted ECT is tolerable and may be efficacious in improving depressive symptoms, but a relative adverse impact on cognition may be an important clinical consideration. Anesthetic agents should be considered based on patient profiles and/or preferences to improve effectiveness and safety of ECT use.
AB - Objective: To meta-analyze clinical efficacy and safety of ketamine compared with other anesthetic agents in the course of electroconvulsive therapy (ECT) in major depressive episode (MDE). Methods: PubMed/MEDLINE, Cochrane Library, Embase, GoogleScholar, and US and European trial registries were searched from inception through May 23, 2023, with no language limits. We included RCTs with (1) a diagnosis of MDE; (2) ECT intervention with ketamine and/or other anesthetic agents; and (3) measures included: depressive symptoms, cognitive performance, remission or response rates, and serious adverse events. Network meta-analysis (NMA) was performed to compare ketamine and 7 other anesthetic agents. Hedges’ g standardized mean differences (SMDs) were used for continuous measures, and relative risks (RRs) were used for other binary outcomes using random-effects models. Results: Twenty-two studies were included in the systematic review. A total of 2322 patients from 17 RCTs were included in the NMA. The overall pooled SMD of ketamine, as compared with propofol as a reference group, was –2.21 (95% confidence interval [CI], –3.79 to –0.64) in depressive symptoms, indicating that ketamine had better antidepressant efficacy than propofol. In a sensitivity analysis, however, ketamine-treated patients had a worse outcome in cognitive performance than propofol-treated patients (SMD, –0.18; 95% CI, –0.28 to –0.09). No other statistically significant differences were found. Conclusions: Ketamine-assisted ECT is tolerable and may be efficacious in improving depressive symptoms, but a relative adverse impact on cognition may be an important clinical consideration. Anesthetic agents should be considered based on patient profiles and/or preferences to improve effectiveness and safety of ECT use.
UR - http://www.scopus.com/inward/record.url?scp=85180218294&partnerID=8YFLogxK
U2 - 10.1038/s41380-023-02366-8
DO - 10.1038/s41380-023-02366-8
M3 - Article
AN - SCOPUS:85180218294
SN - 1359-4184
VL - 29
SP - 750
EP - 759
JO - Molecular Psychiatry
JF - Molecular Psychiatry
IS - 3
ER -