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. 2020 Sep 15:11:562137.
doi: 10.3389/fphar.2020.562137. eCollection 2020.

The Combination of Propofol and Ketamine Does Not Enhance Clinical Responses to Electroconvulsive Therapy in Major Depression-The Results From the KEOpS Study

Jerome Brunelin  1   2 , Sylvain Iceta  1   2   3   4 , Marion Plaze  5 , Raphaël Gaillard  5 , Louis Simon  1   2 , Marie-Françoise Suaud-Chagny  1   2 , Filipe Galvao  1 , Emmanuel Poulet  1   2   6
Affiliations

The Combination of Propofol and Ketamine Does Not Enhance Clinical Responses to Electroconvulsive Therapy in Major Depression-The Results From the KEOpS Study

Jerome Brunelin et al. Front Pharmacol. .

Abstract

Objective: We investigated the clinical effects of the combination of ketamine and propofol as anesthetic agents during electroconvulsive therapy (ECT) in patients with uni- or bipolar major depressive episodes. We hypothesized that ketamine may confer short- and long- term advantages in improving depressive symptoms at the early stages of ECT.

Methods: In a randomized placebo-controlled trial, remission rates after 4 and 8 weeks of ECT were compared between patients who were randomly allocated to receive either the combination of ketamine (0.5 mg/kg) + propofol (n= 11) or placebo + propofol (n = 16). Depressive symptoms were assessed weekly using the Montgomery-Åsberg Depression Rating Scale (MADRS); ECT sessions were administered twice per week for a maximum of 8 weeks (16 sessions).

Results: After 4 weeks, we observed significantly fewer remitters (MADRS score < 10) in the ketamine + propofol group (0/11; 0%) than in the placebo + propofol group (5/16; 31%; χ2 = 4.22; p = 0.040). No significant difference was observed between the two groups regarding the number of patients who achieved remission weekly throughout the study period (Chi² = 3.588; p = 0.058). The mean duration of seizures was significantly shorter in the ketamine + propofol group than in the placebo + propofol group.

Conclusions: The results from the current study corroborated results from previously published studies and did not support the use of the combination of ketamine + propofol as an anesthetic agent for ECT in patients with major depressive episodes in clinical settings.

Keywords: bipolar; electroconvulsive therapy; ketamine; major depressive episode; propofol.

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Figures

Figure 1
Figure 1
Consort flow diagram of participants.
Figure 2
Figure 2
Number of patients who achieved remission (MADRS score < 10) throughout the study period while receiving placebo + propofol or ketamine + propofol during electroconvulsive therapy (ECT).
See this image and copyright information in PMC

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