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Ketamine ineffective for adverse cognitive effects of ECT

Ketamine had no added benefit on neuropsychological and clinical outcomes in depression when added to electroconvulsive therapy, according to recent findings.

“Ketamine has a rapid antidepressant effect after a single dose of IV ketamine, but evidence is unclear about improved symptomatic benefit when ketamine is combined with [electroconvulsive therapy (ECT)],” Ian M Anderson, MD, of University of Manchester, U.K., and colleagues wrote.

To assess effects of ketamine augmentation of ECT for neuropsychological and clinical outcomes in depression, researchers conducted a multicenter, randomized, parallel-group study among individuals diagnosed with moderate or severe unipolar or bipolar depressive episodes. Study participants were randomly assigned to receive 0.5 mg/kg IV ketamine (n = 40) or saline (n = 39) adjunctive to anesthetic for the duration of ECT treatment. Hopkins Verbal Learning Test-Revised was used to assess delayed verbal recall after four ECT treatments.

Compared with saline, ketamine did not improve verbal recall (mean difference = –0.43; 95% CI, –1.73 to 0.87).

Forty-five percent of the ketamine group experienced at least one adverse event, compared with 27% of the saline group. Two participants had transient psychological effects related to ketamine.

“The place of ketamine in combination with ECT has not been finally defined, but our study suggests that there is no beneficial effect when it is given at a standard dose of 0.5 mg during ECT as it is routinely given in the U.K. Future research using small-to-moderate sample sizes is likely to be unhelpful in further resolving the question, and only a sufficiently large future study would be able to address this uncertainty,” the researchers concluded. – by Amanda Oldt

Disclosure: Anderson reports receiving personal fees from Alkermes, Janssen, Lundbeck-Otsuka,

and Takeda. Please see the study for a full list of relevant financial disclosures.