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

TitleAdjunctive ketamine in electroconvulsive therapy: updated systematic review and meta-analysis.
Publication TypeJournal Article
Year of Publication2017
AuthorsMcGirr A, Berlim M, Bond DJ, Chan PY, Yatham LN, Lam RW
JournalBr J Psychiatry
Volume210
Issue6
Pagination403-407
Date Published2017 Jun
ISSN1472-1465
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.

DOI10.1192/bjp.bp.116.195826
Alternate JournalBr J Psychiatry
PubMed ID28385704

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