title: A Bayesian framework systematic review and meta-analysis of anesthetic agents effectiveness/tolerability profile in electroconvulsive therapy for major depression.
abstract: The aim of this study was to assess the efficacy and tolerability/acceptability of 6 anesthetic agents in ECT for depressive disorders. We systematically reviewed 14 double-blind randomized controlled trials (610 participants). Efficacy was measured by the mean scores on validated depression scales at 6 ECT (or the nearest score if not available), number of responders at the end of treatment and seizure duration. The acceptability was measured by the proportion of patients who dropped out of the allocated treatment, and the tolerability by the number of serious adverse events and post-treatment cognition assessment. After excluding the trials responsible for heterogeneity, depression scores of patients who were administered methohexital were found to be significantly more improved than those who received propofol (p = 0.001). On the contrary, those who were administered propofol had lower depression scores than those with thiopental at the end of treatment (p = 0.002). Compared to propofol, methohexital was found to be significantly associated with higher seizure duration (p = 0.018). No difference was found for the acceptability profile (all p > 0.05). In summary, ketamine and methohexital may be preferred to propofol or thiopental in regard of effectiveness in depression scores and increased seizure duration. Further studies are warranted to compare ketamine and methohexital.
authors.affiliation: Université Paris Est-Créteil, Pôle de psychiatrie des hôpitaux universitaires H Mondor DHU Pe-PSY, INSERM U955, Eq Psychiatrie translationelle, Fondation FondaMental Fondation de coopération scientifique en santé mentale, Créteil, France.|Network of Expert centres, FondaMental Foundation, Créteil 94000, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Fond
authors.affiliation: Department of Clinical Psychiatry, CIC-1431, University Hospital of Besançon, EA Neurosciences 481, University of Franche-Comté, Besançon, France.|Network of Expert centres, FondaMental Foundation, Créteil 94000, France.
authors.forename: Djamila
authors.initials: D
authors.lastname: Bennabi
authors.affiliation: Department of Clinical Psychiatry, CIC-1431, University Hospital of Besançon, EA Neurosciences 481, University of Franche-Comté, Besançon, France.|Network of Expert centres, FondaMental Foundation, Créteil 94000, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Haffen
authors.affiliation: Université Paris Est-Créteil, Pôle de psychiatrie des hôpitaux universitaires H Mondor DHU Pe-PSY, INSERM U955, Eq Psychiatrie translationelle, Fondation FondaMental Fondation de coopération scientifique en santé mentale, Créteil, France.
authors.forename: Lore
authors.initials: L
authors.lastname: Brunel
authors.affiliation: Service d'explorations fonctionnelles du système nerveux, Clinique du sommeil, CHU de Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France.
authors.forename: Jean-Arthur
authors.initials: JA
authors.lastname: Micoulaud-Franchi
authors.affiliation: Aix-Marseille University, EA 3279 Research Unit - Public Health: Chronic diseases and quality of life, Marseille, France.
authors.forename: Anderson
authors.initials: A
authors.lastname: Loundou
authors.affiliation: Service d'explorations fonctionnelles du système nerveux, Clinique du sommeil, CHU de Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France.|Aix-Marseille University, EA 3279 Research Unit - Public Health: Chronic diseases and quality of life, Marseille, France.|Network of Expert centres, FondaMental Foundation, Créteil 94000, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Lançon
authors.affiliation: Network of Expert centres, FondaMental Foundation, Créteil 94000, France.|University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: Pierre-Michel
authors.initials: PM
authors.lastname: Llorca
authors.affiliation: Aix-Marseille University, EA 3279 Research Unit - Public Health: Chronic diseases and quality of life, Marseille, France.|Department of Epidemiology, Timone University Hospital, APHM, Marseille, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Auquier
authors.affiliation: Aix-Marseille University, EA 3279 Research Unit - Public Health: Chronic diseases and quality of life, Marseille, France.|Department of Epidemiology, Timone University Hospital, APHM, Marseille, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Boyer
mesh_terms: D000777:Anesthetics / Q000009:adverse effects / Q000627:therapeutic use*; D001499:Bayes Theorem; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000473:pathology; D004565:Electroconvulsive Therapy; D004569:Electroencephalography; D006801:Humans; D007649:Ketamine / Q000009:adverse effects / Q000627:therapeutic use; D008723:Methohexital / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012640:Seizures / Q000188:drug therapy* / Q000473:pathology
chemical_list: D000777:Anesthetics; D007649:Ketamine; D008723:Methohexital