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Br J Psychiatry. 2017 Jun;210(6):403-407. doi: 10.1192/bjp.bp.116.195826. Epub 2017 Apr 6.

Adjunctive ketamine in electroconvulsive therapy: updated systematic review and meta-analysis.

Author information

1
Alexander McGirr, MD, MSc, Department of Psychiatry, University of British Columbia, Vancouver; Marcelo T. Berlim, MD, MSc, Neuromodulation Research Clinic, Depressive Disorders Program, Douglas Mental Health University Institute and McGill University, Montréal, Québec, Canada; David J. Bond, MD, PhD, Department of Psychiatry, University of Minnesota, Minneapolis, USA; Peter Y. Chan, MD, Department of Psychiatry, University of British Columbia, and Neurostimulation Service, Vancouver General Hospital, Vancouver; Lakshmi N. Yatham, MBBS, Raymond W. Lam, MD, Department of Psychiatry and Mood Disorders Centre of Excellence, University of British Columbia, Vancouver, Canada alexander.mcgirr@alumni.ubc.ca.
2
Alexander McGirr, MD, MSc, Department of Psychiatry, University of British Columbia, Vancouver; Marcelo T. Berlim, MD, MSc, Neuromodulation Research Clinic, Depressive Disorders Program, Douglas Mental Health University Institute and McGill University, Montréal, Québec, Canada; David J. Bond, MD, PhD, Department of Psychiatry, University of Minnesota, Minneapolis, USA; Peter Y. Chan, MD, Department of Psychiatry, University of British Columbia, and Neurostimulation Service, Vancouver General Hospital, Vancouver; Lakshmi N. Yatham, MBBS, Raymond W. Lam, MD, Department of Psychiatry and Mood Disorders Centre of Excellence, University of British Columbia, Vancouver, Canada.

Abstract

BackgroundKetamine has emerged as a novel therapeutic agent for major depressive episodes, spurring interest in its potential to augment electroconvulsive therapy (ECT).AimsWe sought to update our preliminary systematic review and meta-analysis, focusing on randomised controlled trials (RCTs) involving an index course of ECT, and testing the hypothesis that lack of efficacy is due to barbiturate anaesthetic co-administration.MethodWe searched EMBASE, CENTRAL and Medline to identify RCTs examining the efficacy of ketamine during a course of ECT. Data were synthesised from ten trials (ketamine group n = 333, comparator group n = 269) using pooled random effects models.ResultsElectroconvulsive therapy with ketamine was not associated with greater improvements in depressive symptoms or higher rates of clinical response or remission, nor did it result in pro-cognitive effects. This held true when limiting analysis to trials without barbiturate anaesthetic co-administration. Increased rates of confusion were reported.ConclusionsOverall, our analyses do not support using ketamine over other induction agents in ECT.

PMID:
28385704
DOI:
10.1192/bjp.bp.116.195826
[Indexed for MEDLINE]

Conflict of interest statement

Declaration of interestD.J.B. has received speaking fees or acted as a consultant for the Canadian Network for Mood and Anxiety Treatments (CANMAT), the Canadian Psychiatric Association, Pfizer, Sunovion, BMS, Otsuka, Astra-Zeneca, Janssen-Ortho and Myriad, and has received research support from the Canadian Institutes of Health Research (CIHR), the UBC Institute of Mental Health/Coast Capital Depression Research Fund, and Pfizer. L.N.Y. has received research grants from, or is on speaking/advisory boards for, AstraZeneca, Bristol-Myers Squibb, CIHR CANMAT, Eli Lilly, GlaxoSmithKline, Janssen, Michael Smith Foundation for Health Research, Novartis, Pfizer, Ranbaxy, Servier, and the Stanley Foundation. R.W.L. is on ad hoc speaking/advisory boards for, or has received research funds from, Asia-Pacific Economic Cooperation, AstraZeneca, BC Leading Edge Foundation, Brain Canada, Bristol-Myers Squibb, CIHR, Canadian Depression Research and Intervention Network, CANMAT, Canadian Psychiatric Association, Janssen, Lundbeck Institute, Medscape, Pfizer, St. Jude Medical, Takeda, University Health Network Foundation, Vancouver Coastal Health Research Institute, and VGH Foundation.

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