Efficacy of ketamine, propofol, and dexmedetomidine for anesthesia in electroconvulsive therapy in treatment-resistant major depressive disorder patients: a double-blind randomized clinical trial

Abstract

Electroconvulsive therapy (ECT) is one of the therapeutic opportunities for patients with psychological disorders when they may decline to take medication. We sought to systematically compare the anesthetic efficacy of ketamine, propofol, and dexmedetomidine for electroconvulsive therapy in treatment-resistant major depressive disorder patients. This double-blind trial enrolled treatment-resistant major depressive disorder patients (n = 85) who had been hospitalized for ECT in the Amir Kabir Hospital's psychiatric ward (Arak, Iran). The ketamine, propofol, and dexmedetomidine groups received a dose of 0.2 μg/kg ketamine, 1.5 mg/kg propofol, and 0.8 mg/kg dexmedetomidine, respectively. In all intervention groups, 10 mL of interventional drugs was injected intravenously for 10 minutes, and in the placebo group, 10 mL of normal saline was given over the same period. The dexmedetomidine group's blood pressure was revealed comparatively lower at all times. Dexmedetomidine-treated patients showed their marked satisfaction, while those treated with propofol had shorter recovery time, shorter seizure duration, and shorter time to achieve an Aldrete score of 9-10 and increased relaxation, and next dexmedetomidine produced deeper relaxation. Propofol could shorten recovery time and seizure duration, and enhance relaxation, while dexmedetomidine was associated with higher patient satisfaction. Considering that any anesthetic which does not shorten seizure duration may serve efficiently for ECT and that ketamine-treated patients had more prolonged seizure duration, the preferred drug can hence be considered from various angles, thereby offering anesthetic agents with highly favorable efficacy in treatment-resistant major depressive disorder patients needing ECT. The drug choice thus depends on physical conditions, underlying diseases, and psychiatrist consultation.

Keywords: analgesics; depressive disorder; dexmedetomidine; electroconvulsive therapy; ketamine; propofol; psychological disorders; seizure.

Figure 1

CONsolidated Standards Of Reporting Trials (CONSORT) diagram showing the flow of the clinical randomized trial. Note: DEX: Dexmedetomidine; KET: ketamine; PBO: placebo; PRO: propofol.

Figure 2

Effect of ketamine (KET), propofol (PRO), and dexmedetomidine (DEX) on the blood pressure during anesthesia of electroconvulsive therapy (ECT) in treatment-resistant major depressive disorder patients. Note: Data are expressed as mean ± SD (n =17 per group) and were analyzed by repeated measurement test. BP was lower in the DEX group at all times after ECT (P < 0.05). But the other three groups including ketamine, propofol, and placebo (PBO) groups had similar BP at different times after ECT.