title: Rapid antidepressant effect of ketamine in the electroconvulsive therapy setting.
abstract: OBJECTIVE
  Studies now provide strong evidence that the N-methyl-D-aspartate receptor antagonist ketamine possesses rapidly acting antidepressant properties. This study aimed to determine if a low dose of ketamine could be used to expedite and augment the antidepressant effects of electroconvulsive therapy (ECT) treatments in patients experiencing a severe depressive episode.
  
  
  METHODS
  Subjects with major depressive disorder or bipolar disorder referred for ECT treatment of a major depressive episode were randomized to receive thiopental alone or thiopental plus ketamine (0.5 mg/kg) for anesthesia before each ECT session. The Hamilton Depression Rating Scale (HDRS) was administered at baseline and at 24 to 72 hours after the first and sixth ECT sessions.
  
  
  RESULTS
  Electroconvulsive therapy exerted a significant antidepressant effect in both groups (F2,24 = 14.35, P < 0.001). However, there was no significant group effect or group-by-time interaction on HDRS scores. In addition, post hoc analyses of the time effect on HDRS showed no significant HDRS reduction after the first ECT session for either group.
  
  
  CONCLUSIONS
  The results of this pilot study suggest that ketamine, at a dose of 0.5 mg/kg, given just before ECT, did not enhance the antidepressant effect of ECT. Interestingly, the results further suggest that the coadministration of ketamine with a barbiturate anesthetic and ECT may attenuate the immediate antidepressant effects of the N-methyl-D-aspartate antagonist.
authors: Department of Psychiatry and the Ribicoff Research Facilities, Yale University School of Medicine, New Haven, CT, USA.
authors: Chadi G
authors: CG
authors: Abdallah
authors: Madonna
authors: M
authors: Fasula
authors: Ben
authors: B
authors: Kelmendi
authors: Gerard
authors: G
authors: Sanacora
authors: Robert
authors: R
authors: Ostroff
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000758:Anesthesia; D000778:Anesthetics, Dissociative / Q000009:adverse effects / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000523:psychology / Q000628:therapy; D003131:Combined Modality Therapy; D003863:Depression / Q000523:psychology / Q000628:therapy*; D003865:Major Depressive Disorder / Q000523:psychology / Q000628:therapy; D004565:Electroconvulsive Therapy / Q000009:adverse effects; D004569:Electroencephalography; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives; D007649:Ketamine / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012640:Seizures / Q000503:physiopathology; D013874:Thiopental; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000778:Anesthetics, Dissociative; D000928:Antidepressive Agents; D006993:Hypnotics and Sedatives; D007649:Ketamine; D013874:Thiopental