The purpose of this prospective randomized clinical trial is to determine if patients receiving ketamine as part of general anesthesia during ECT rather than standard of care will have improvement in symptoms of depression after a course of ECT treatments (n≈50).
Randomized, double-blind, parallel-group trial in VA patients undergoing ECT comparing ketamine (1.0 mg/kg IV) versus methohexital (1.0 mg/kg IV) for induction across the ECT index course.
Primary outcomes are change in depression scores (PHQ-9 and HAM-D) from baseline to final ECT; secondary outcomes include cognitive status (MoCA), seizure quality (EEG), cerebral oximetry, serum metabolites (kynurenine, D/L-serine, glutamate intermediates), and relapse/need for further ECT within 1 year.
Approximately 50 veterans receiving care at VA Puget Sound will be randomized; operative ECT clinicians are unblinded while outcome assessors and participants are blinded.
1.0 mg/kg IV ketamine for induction during ECT index course (over 2–3 weeks).
Ketalar
1.0 mg/kg IV methohexital for induction during ECT index course (over 2–3 weeks).
Methohexital (Brevital)