Cobb Kathryn, Nanda Monika
Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Curr Opin Anaesthesiol. 2018 Aug;31(4):459-462. doi: 10.1097/ACO.0000000000000607.
Anesthetics, such as thiopental, methohexital, propofol and ketamine have been used to induce unconsciousness for electroconvulsive therapy (ECT), each with its advantages and disadvantages. Only until recently was it discovered that ketamine may have inherent antidepressant effects. We reviewed the side effect profile of ketamine and examined the literature for whether or not ketamine augments the antidepressant effects of ECT.
Systematic reviews and meta-analyses of randomized controlled trials of the potential benefits of adding ketamine to ECT treatment have generated varied conclusions. Currently there is a lack of clear evidence that ketamine with ECT is more efficacious than ECT alone.
Large, multicenter randomized controlled trials are needed to further investigate the potential advantages of adding ketamine to ECT for patients with severe or refractory depression. The addition of ketamine to ECT treatment may have some early beneficial effect in patients with acute depressive disorders. Most likely, ECT itself is responsible for lasting remission from severe depression. Ketamine's side effect profile may be undesirable in certain patient populations, and so the risks and benefits of the addition of this drug to ECT treatment must be weighed.
诸如硫喷妥钠、美索比妥、丙泊酚和氯胺酮等麻醉剂已被用于电休克治疗（ECT）中诱导意识丧失，每种药物都有其优缺点。直到最近才发现氯胺酮可能具有内在的抗抑郁作用。我们回顾了氯胺酮的副作用概况，并查阅文献以研究氯胺酮是否能增强ECT的抗抑郁效果。
对将氯胺酮添加到ECT治疗中的潜在益处进行的随机对照试验的系统评价和荟萃分析得出了不同的结论。目前缺乏明确证据表明氯胺酮联合ECT比单纯ECT更有效。
需要开展大型多中心随机对照试验，以进一步研究对重度或难治性抑郁症患者在ECT中添加氯胺酮的潜在优势。在急性抑郁症患者中，在ECT治疗中添加氯胺酮可能会产生一些早期有益效果。ECT本身很可能是重度抑郁症持续缓解的原因。氯胺酮的副作用在某些患者群体中可能不理想，因此必须权衡在ECT治疗中添加这种药物的风险和益处。
