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

  • Alexander McGirr (a1), Marcelo T. Berlim (a2), David J. Bond (a3), Peter Y. Chan (a4), Lakshmi N. Yatham (a5) and Raymond W. Lam (a5)...

Abstract

Background

Ketamine has emerged as a novel therapeutic agent for major depressive episodes, spurring interest in its potential to augment electroconvulsive therapy (ECT).

Aims

We 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.

Method

We 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.

Results

Electroconvulsive 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.

Conclusions

Overall, our analyses do not support using ketamine over other induction agents in ECT.

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Copyright

Corresponding author

Dr Alexander McGirr, 11th Floor, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada. Email: alexander.mcgirr@alumni.ubc.ca

Footnotes

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Declaration of interest

D.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.

Footnotes

References

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

  • Alexander McGirr (a1), Marcelo T. Berlim (a2), David J. Bond (a3), Peter Y. Chan (a4), Lakshmi N. Yatham (a5) and Raymond W. Lam (a5)...

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

  • Alexander McGirr (a1), Marcelo T. Berlim (a2), David J. Bond (a3), Peter Y. Chan (a4), Lakshmi N. Yatham (a5) and Raymond W. Lam (a5)...
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