Ketamine plus propofol-electroconvulsive therapy (ECT) transiently improves the antidepressant effects and the associated brain functional alterations in patients with propofol-ECT-resistant depression
This open-label study (n=28) investigated whether ketamine (35mg/70kg) treatment prior to propofol-assisted electroconvulsive therapy (ECT) can improve clinical symptoms of depression. The addition of ketamine improved treatment, and this was accompanied by increased global functional connectivity density in the left temporal and subgenual anterior cingulated cortex and decreased functional connectivity strength within the default mode network for a period of 10 days. However, the remission of depressive symptoms only lasted 7 days.
Authors
- Zhang, J.
- Tian, H.
- Li, J.
Published
Abstract
Introduction
New methods for using ketamine in patients with propofol-electroconvulsive therapy-resistant depression (ECTRD) are needed in the clinic.
Methods
This study aimed to investigate the therapeutic efficacy of ketamine plus ECT in ECT-RD patients, along with the treatment-induced brain alterations. A total of 28 ECT-RD patients were intravenously injected with ketamine six times and treated with propofol-ECT six times alternately within two weeks. The Hamilton Depression Scale was used to assess the treatment effect. Global functional connectivity density (gFCD) and functional connectivity strength (FCS) were used to evaluate functional brain alterations.
Results
As compared with the propofol-ECT treatment group, the addition of ketamine could improve the therapeutic outcomes in patients with ECT-RD. The treatment increased gFCD in the left temporal and subgenual anterior cingulated cortex. Simultaneously, the treatment decreased FCS within the default mode network. Although increased functional connectivity could be sustained for 10 days, the clinical effect was only sustained 7 days, indicating that the clinical effect and functional brain alterations were disjointed.
Discussion
Ketamine plus propofol-ECT can obviously improve the effects of propofol-ECT in ECT-RD patients. However, the effect is limited in 7 days, suggesting the benefit is short-term.
Research Summary of 'Ketamine plus propofol-electroconvulsive therapy (ECT) transiently improves the antidepressant effects and the associated brain functional alterations in patients with propofol-ECT-resistant depression'
Introduction
Depression remains highly prevalent and often refractory to treatment, with many patients classified as treatment-resistant after failing adequate courses of antidepressants from at least two pharmacological classes and psychotherapeutic interventions. Electroconvulsive therapy (ECT) and other neuromodulation approaches provide options for treatment-resistant depression (TRD), but a substantial subset of patients do not respond to ECT administered under propofol anaesthesia; the investigators label these individuals as having ECT-resistant depression (ECT-RD). Prior studies have reported short-lived antidepressant effects of ketamine and ketamine-related alterations in brain structure and function, but the utility of combining ketamine with ECT (or as an anaesthetic during ECT) remains uncertain and may carry safety concerns including cardiovascular and addiction risks. Zhang and colleagues conducted a pilot study to test whether alternating intravenous low-dose ketamine and propofol-anaesthetised bilateral ECT over two weeks improves clinical outcomes and induces measurable changes in brain functional connectivity in patients with propofol-ECT-resistant depression. The study aimed to characterise both the time course of clinical response, assessed by the 17-item Hamilton Depression Rating Scale (HAMD-17), and treatment-associated changes in global functional connectivity density (gFCD) and functional connectivity strength (FCS) within the default mode network (DMN) using repeated resting-state fMRI assessments.
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Study Details
- Study Typeindividual
- Journal
- Compound
- Topics
- APA Citation
Zhang, J., Tian, H., Li, J., Ji, S., Chen, S., Zhu, J., Jiang, D., Wang, L., Li, G., Chen, M., Wang, W., Lin, X., & Zhuo, C. (2020). Ketamine plus propofol-electroconvulsive therapy (ECT) transiently improves the antidepressant effects and the associated brain functional alterations in patients with propofol-ECT-resistant depression. Psychiatry Research, 287, 112907. https://doi.org/10.1016/j.psychres.2020.112907
References (2)
Papers cited by this study that are also in Blossom
Bobo, W. V., Vande Voort, J. L., Croarkin, P. E. et al. · Depression and Anxiety (2016)
Schwartz, J., Murrough, J. W., Iosifescu, D. V. · Evidence-Based Mental Health (2016)
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