title: Significant treatment effect of add-on ketamine anesthesia in electroconvulsive therapy in depressive patients: A meta-analysis.
abstract: Add-on ketamine anesthesia in electroconvulsive therapy (ECT) has been studied in depressive patients in several clinical trials with inconclusive findings. Two most recent meta-analyses reported insignificant findings with regards to the treatment effect of add-on ketamine anesthesia in ECT in depressive patients. The aim of this study is to update the current evidence and investigate the role of add-on ketamine anesthesia in ECT in depressive patients via a systematic review and meta-analysis. We performed a thorough literature search of the PubMed and ScienceDirect databases, and extracted all relevant clinical variables to compare the antidepressive outcomes between add-on ketamine anesthesia and other anesthetics in ECT. Total 16 articles with 346 patients receiving add-on ketamine anesthesia in ECT and 329 controls were recruited. We found that the antidepressive treatment effect of add-on ketamine anesthesia in ECT in depressive patients was significantly higher than that of other anesthetics (p<0.001). This significance persisted in both short-term (1-2 weeks) and moderate-term (3-4 weeks) treatment courses (all p<0.05). However, the side effect profiles and recovery time profiles were significantly worse in add-on ketamine anesthesia group than in control group. Our meta-analysis highlights the significantly higher antidepressive treatment effect of add-on ketamine in depressive patients receiving ECT compared to other anesthetics. However, clinicians need to take undesirable side effects into consideration when using add-on ketamine anesthesia in ECT in depressive patients.
authors.affiliation: Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan; Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan.
authors.forename: Dian-Jeng
authors.initials: DJ
authors.lastname: Li
authors.affiliation: Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan.
authors.forename: Fu-Chiang
authors.initials: FC
authors.lastname: Wang
authors.affiliation: Department of Psychiatry, Puli Branch, Taichung Veterans General Hospital, Taiwan.
authors.forename: Che-Sheng
authors.initials: CS
authors.lastname: Chu
authors.affiliation: Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Tien-Yu
authors.initials: TY
authors.lastname: Chen
authors.affiliation: Department of Psychiatry, Tainan Hospital, Ministry of Health and Welfare, Taiwan.
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Tang
authors.affiliation: Department of Adult Psychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan.
authors.forename: Wei-Cheng
authors.initials: WC
authors.lastname: Yang
authors.affiliation: Department of Child and Adolescent Psychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan.
authors.forename: Philip Chik-Keung
authors.initials: PC
authors.lastname: Chow
authors.affiliation: Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai׳s Home, Taiwan.
authors.forename: Ching-Kuan
authors.initials: CK
authors.lastname: Wu
authors.affiliation: Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai׳s Home, Taiwan. Electronic address: ducktseng@gmail.com.
authors.forename: Ping-Tao
authors.initials: PT
authors.lastname: Tseng
authors.affiliation: Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan; Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. Electronic address: py1029@adm.cgmh.org.tw.
authors.forename: Pao-Yen
authors.initials: PY
authors.lastname: Lin
mesh_terms: D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D003863:Depression / Q000628:therapy*; D004565:Electroconvulsive Therapy / Q000379:methods*; D018691:Excitatory Amino Acid Antagonists / Q000627:therapeutic use*; D007649:Ketamine / Q000627:therapeutic use*
chemical_list: D018691:Excitatory Amino Acid Antagonists; D007649:Ketamine
keywords: Depression; NMDA; Psychiatry; Treatment