title: Adjunctive ketamine in electroconvulsive therapy: updated systematic review and meta-analysis.
abstract: BackgroundKetamine has emerged as a novel therapeutic agent for major depressive episodes, spurring interest in its potential to augment electroconvulsive therapy (ECT).AimsWe sought to update our preliminary systematic review and meta-analysis, focusing on randomised controlled trials (RCTs) involving an index course of ECT, and testing the hypothesis that lack of efficacy is due to barbiturate anaesthetic co-administration.MethodWe searched EMBASE, CENTRAL and Medline to identify RCTs examining the efficacy of ketamine during a course of ECT. Data were synthesised from ten trials (ketamine groupn= 333, comparator groupn= 269) using pooled random effects models.ResultsElectroconvulsive therapy with ketamine was not associated with greater improvements in depressive symptoms or higher rates of clinical response or remission, nor did it result in pro-cognitive effects. This held true when limiting analysis to trials without barbiturate anaesthetic co-administration. Increased rates of confusion were reported.ConclusionsOverall, our analyses do not support using ketamine over other induction agents in ECT.
authors.affiliation: Alexander McGirr, MD, MSc, Department of Psychiatry, University of British Columbia, Vancouver; Marcelo T. Berlim, MD, MSc, Neuromodulation Research Clinic, Depressive Disorders Program, Douglas Mental Health University Institute and McGill University, Montréal, Québec, Canada; David J. Bond, MD, PhD, Department of Psychiatry, University of Minnesota, Minneapolis, USA; Peter Y. Chan, MD, Department of Psychiatry, University of British Columbia, and Neurostimulation Service, Vancouver General Hospital, Vancouver; Lakshmi N. Yatham, MBBS, Raymond W. Lam, MD, Department of Psychiatry and Mood Disorders Centre of Excellence, University of British Columbia, Vancouver, Canada alexander.mcgirr@alumni.ubc.ca.
authors.forename: Alexander
authors.initials: A
authors.lastname: McGirr
authors.affiliation: Alexander McGirr, MD, MSc, Department of Psychiatry, University of British Columbia, Vancouver; Marcelo T. Berlim, MD, MSc, Neuromodulation Research Clinic, Depressive Disorders Program, Douglas Mental Health University Institute and McGill University, Montréal, Québec, Canada; David J. Bond, MD, PhD, Department of Psychiatry, University of Minnesota, Minneapolis, USA; Peter Y. Chan, MD, Department of Psychiatry, University of British Columbia, and Neurostimulation Service, Vancouver General Hospital, Vancouver; Lakshmi N. Yatham, MBBS, Raymond W. Lam, MD, Department of Psychiatry and Mood Disorders Centre of Excellence, University of British Columbia, Vancouver, Canada.
authors.forename: Marcelo T
authors.initials: MT
authors.lastname: Berlim
authors.affiliation: Alexander McGirr, MD, MSc, Department of Psychiatry, University of British Columbia, Vancouver; Marcelo T. Berlim, MD, MSc, Neuromodulation Research Clinic, Depressive Disorders Program, Douglas Mental Health University Institute and McGill University, Montréal, Québec, Canada; David J. Bond, MD, PhD, Department of Psychiatry, University of Minnesota, Minneapolis, USA; Peter Y. Chan, MD, Department of Psychiatry, University of British Columbia, and Neurostimulation Service, Vancouver General Hospital, Vancouver; Lakshmi N. Yatham, MBBS, Raymond W. Lam, MD, Department of Psychiatry and Mood Disorders Centre of Excellence, University of British Columbia, Vancouver, Canada.
authors.forename: David J
authors.initials: DJ
authors.lastname: Bond
authors.affiliation: Alexander McGirr, MD, MSc, Department of Psychiatry, University of British Columbia, Vancouver; Marcelo T. Berlim, MD, MSc, Neuromodulation Research Clinic, Depressive Disorders Program, Douglas Mental Health University Institute and McGill University, Montréal, Québec, Canada; David J. Bond, MD, PhD, Department of Psychiatry, University of Minnesota, Minneapolis, USA; Peter Y. Chan, MD, Department of Psychiatry, University of British Columbia, and Neurostimulation Service, Vancouver General Hospital, Vancouver; Lakshmi N. Yatham, MBBS, Raymond W. Lam, MD, Department of Psychiatry and Mood Disorders Centre of Excellence, University of British Columbia, Vancouver, Canada.
authors.forename: Peter Y
authors.initials: PY
authors.lastname: Chan
authors.affiliation: Alexander McGirr, MD, MSc, Department of Psychiatry, University of British Columbia, Vancouver; Marcelo T. Berlim, MD, MSc, Neuromodulation Research Clinic, Depressive Disorders Program, Douglas Mental Health University Institute and McGill University, Montréal, Québec, Canada; David J. Bond, MD, PhD, Department of Psychiatry, University of Minnesota, Minneapolis, USA; Peter Y. Chan, MD, Department of Psychiatry, University of British Columbia, and Neurostimulation Service, Vancouver General Hospital, Vancouver; Lakshmi N. Yatham, MBBS, Raymond W. Lam, MD, Department of Psychiatry and Mood Disorders Centre of Excellence, University of British Columbia, Vancouver, Canada.
authors.forename: Lakshmi N
authors.initials: LN
authors.lastname: Yatham
authors.affiliation: Alexander McGirr, MD, MSc, Department of Psychiatry, University of British Columbia, Vancouver; Marcelo T. Berlim, MD, MSc, Neuromodulation Research Clinic, Depressive Disorders Program, Douglas Mental Health University Institute and McGill University, Montréal, Québec, Canada; David J. Bond, MD, PhD, Department of Psychiatry, University of Minnesota, Minneapolis, USA; Peter Y. Chan, MD, Department of Psychiatry, University of British Columbia, and Neurostimulation Service, Vancouver General Hospital, Vancouver; Lakshmi N. Yatham, MBBS, Raymond W. Lam, MD, Department of Psychiatry and Mood Disorders Centre of Excellence, University of British Columbia, Vancouver, Canada.
authors.forename: Raymond W
authors.initials: RW
authors.lastname: Lam
mesh_terms: D003131:Combined Modality Therapy; D003221:Confusion / Q000139:chemically induced; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000628:therapy*; D004565:Electroconvulsive Therapy; D006801:Humans; D007649:Ketamine / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D007649:Ketamine