title: Ketamine as the anaesthetic for electroconvulsive therapy: the KANECT randomised controlled trial.
abstract: BackgroundKetamine has recently become an agent of interest as an acute treatment for severe depression and as the anaesthetic for electroconvulsive therapy (ECT). Subanaesthetic doses result in an acute reduction in depression severity while evidence is equivocal for this antidepressant effect with anaesthetic or adjuvant doses. Recent systematic reviews call for high-quality evidence from further randomised controlled trials (RCTs).AimsTo establish if ketamine as the anaesthetic for ECT results in fewer ECT treatments, improvements in depression severity ratings and less memory impairment than the standard anaesthetic.MethodDouble-blind, parallel-design, RCT of intravenous ketamine (up to 2 mg/kg) with an active comparator, intravenous propofol (up to 2.5 mg/kg), as the anaesthetic for ECT in patients receiving ECT for major depression on an informal basis. (Trial registration: European Clinical Trials Database (EudraCT): 2011-000396-14 and clinicalTrials.gov: NCT01306760)ResultsNo significant differences were found on any outcome measure during, at the end of or 1 month following the ECT course.ConclusionsKetamine as an anaesthetic does not enhance the efficacy of ECT.
authors.affiliation: Gordon Fernie, PhD, Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen. Aberdeen, UK; James Currie, MBChB, BSc, Jennifer S. Perrin, PhD, NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK; Caroline A. Stewart, BSc, PhD, Division of Neuroscience, University of Dundee, Dundee, UK; Virginica Anderson, MD, FRCA, NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK; Daniel M. Bennett, MBChB, MRCPsych, MD, MMED, Division of Applied Medicine (Psychiatry), University of Aberdeen, Aberdeen and NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK; Steven Hay, MBChB, MRCPsych, NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK; Ian C. Reid (deceased), PhD, MRCPsych, previously at Division of Applied Medicine (Psychiatry), University of Aberdeen, Aberdeen and NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK g.fernie@abdn.ac.uk.
authors.forename: Gordon
authors.initials: G
authors.lastname: Fernie
authors.affiliation: Gordon Fernie, PhD, Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen. Aberdeen, UK; James Currie, MBChB, BSc, Jennifer S. Perrin, PhD, NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK; Caroline A. Stewart, BSc, PhD, Division of Neuroscience, University of Dundee, Dundee, UK; Virginica Anderson, MD, FRCA, NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK; Daniel M. Bennett, MBChB, MRCPsych, MD, MMED, Division of Applied Medicine (Psychiatry), University of Aberdeen, Aberdeen and NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK; Steven Hay, MBChB, MRCPsych, NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK; Ian C. Reid (deceased), PhD, MRCPsych, previously at Division of Applied Medicine (Psychiatry), University of Aberdeen, Aberdeen and NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK.
authors.forename: James
authors.initials: J
authors.lastname: Currie
authors.affiliation: Gordon Fernie, PhD, Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen. Aberdeen, UK; James Currie, MBChB, BSc, Jennifer S. Perrin, PhD, NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK; Caroline A. Stewart, BSc, PhD, Division of Neuroscience, University of Dundee, Dundee, UK; Virginica Anderson, MD, FRCA, NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK; Daniel M. Bennett, MBChB, MRCPsych, MD, MMED, Division of Applied Medicine (Psychiatry), University of Aberdeen, Aberdeen and NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK; Steven Hay, MBChB, MRCPsych, NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK; Ian C. Reid (deceased), PhD, MRCPsych, previously at Division of Applied Medicine (Psychiatry), University of Aberdeen, Aberdeen and NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Perrin
authors.affiliation: Gordon Fernie, PhD, Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen. Aberdeen, UK; James Currie, MBChB, BSc, Jennifer S. Perrin, PhD, NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK; Caroline A. Stewart, BSc, PhD, Division of Neuroscience, University of Dundee, Dundee, UK; Virginica Anderson, MD, FRCA, NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK; Daniel M. Bennett, MBChB, MRCPsych, MD, MMED, Division of Applied Medicine (Psychiatry), University of Aberdeen, Aberdeen and NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK; Steven Hay, MBChB, MRCPsych, NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK; Ian C. Reid (deceased), PhD, MRCPsych, previously at Division of Applied Medicine (Psychiatry), University of Aberdeen, Aberdeen and NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK.
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Stewart
authors.affiliation: Gordon Fernie, PhD, Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen. Aberdeen, UK; James Currie, MBChB, BSc, Jennifer S. Perrin, PhD, NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK; Caroline A. Stewart, BSc, PhD, Division of Neuroscience, University of Dundee, Dundee, UK; Virginica Anderson, MD, FRCA, NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK; Daniel M. Bennett, MBChB, MRCPsych, MD, MMED, Division of Applied Medicine (Psychiatry), University of Aberdeen, Aberdeen and NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK; Steven Hay, MBChB, MRCPsych, NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK; Ian C. Reid (deceased), PhD, MRCPsych, previously at Division of Applied Medicine (Psychiatry), University of Aberdeen, Aberdeen and NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK.
authors.forename: Virginica
authors.initials: V
authors.lastname: Anderson
authors.affiliation: Gordon Fernie, PhD, Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen. Aberdeen, UK; James Currie, MBChB, BSc, Jennifer S. Perrin, PhD, NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK; Caroline A. Stewart, BSc, PhD, Division of Neuroscience, University of Dundee, Dundee, UK; Virginica Anderson, MD, FRCA, NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK; Daniel M. Bennett, MBChB, MRCPsych, MD, MMED, Division of Applied Medicine (Psychiatry), University of Aberdeen, Aberdeen and NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK; Steven Hay, MBChB, MRCPsych, NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK; Ian C. Reid (deceased), PhD, MRCPsych, previously at Division of Applied Medicine (Psychiatry), University of Aberdeen, Aberdeen and NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Bennett
authors.affiliation: Gordon Fernie, PhD, Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen. Aberdeen, UK; James Currie, MBChB, BSc, Jennifer S. Perrin, PhD, NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK; Caroline A. Stewart, BSc, PhD, Division of Neuroscience, University of Dundee, Dundee, UK; Virginica Anderson, MD, FRCA, NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK; Daniel M. Bennett, MBChB, MRCPsych, MD, MMED, Division of Applied Medicine (Psychiatry), University of Aberdeen, Aberdeen and NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK; Steven Hay, MBChB, MRCPsych, NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK; Ian C. Reid (deceased), PhD, MRCPsych, previously at Division of Applied Medicine (Psychiatry), University of Aberdeen, Aberdeen and NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK.
authors.forename: Steven
authors.initials: S
authors.lastname: Hay
authors.affiliation: Gordon Fernie, PhD, Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen. Aberdeen, UK; James Currie, MBChB, BSc, Jennifer S. Perrin, PhD, NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK; Caroline A. Stewart, BSc, PhD, Division of Neuroscience, University of Dundee, Dundee, UK; Virginica Anderson, MD, FRCA, NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK; Daniel M. Bennett, MBChB, MRCPsych, MD, MMED, Division of Applied Medicine (Psychiatry), University of Aberdeen, Aberdeen and NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK; Steven Hay, MBChB, MRCPsych, NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK; Ian C. Reid (deceased), PhD, MRCPsych, previously at Division of Applied Medicine (Psychiatry), University of Aberdeen, Aberdeen and NHS Grampian, Royal Cornhill Hospital, Aberdeen, UK.
authors.forename: Ian C
authors.initials: IC
authors.lastname: Reid
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000777:Anesthetics / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000628:therapy; D004311:Double-Blind Method; D004565:Electroconvulsive Therapy; D005260:Female; D006801:Humans; D007649:Ketamine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000777:Anesthetics; D000928:Antidepressive Agents; D007649:Ketamine; D015742:Propofol