Basso Laura, Bönke Luisa, Aust Sabine, Gärtner Matti, Heuser-Collier Isabella, Otte Christian, Wingenfeld Katja, Bajbouj Malek, Grimm Simone
Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt - Universität zu Berlin, Berlin Institute of Health, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland.
Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt - Universität zu Berlin, Berlin Institute of Health, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
J Psychiatr Res. 2020 Apr;123:1-8. doi: 10.1016/j.jpsychires.2020.01.002. Epub 2020 Jan 16.
While electroconvulsive therapy (ECT) is considered the gold standard for acute treatment of patients with otherwise treatment-resistant depression, ketamine has recently emerged as a fast-acting treatment alternative for these patients. Efficacy and onset of action are currently among the main factors that influence clinical decision making, however, the effect of these treatments on cognitive functions should also be a crucial point, given that cognitive impairment in depression is strongly related to disease burden and functional recovery. ECT is known to induce transient cognitive impairment, while little is known about ketamine's impact on cognition. This study therefore aims to compare ECT and serial ketamine administration not only with regard to their antidepressant efficacy but also to acute neurocognitive effects.
Fifty patients suffering from depression were treated with either serial ketamine infusions or ECT. Depression severity and cognitive functions were assessed before, during, and after treatment.
ECT and ketamine administration were equally effective, however, the antidepressant effects of ketamine occurred faster. Ketamine improved neurocognitive functioning, especially attention and executive functions, whereas ECT was related to a small overall decrease in cognitive performance.
Due to its pro-cognitive effects and faster antidepressant effect, serial ketamine administration might be a more favorable short-term treatment option than ECT.
As this research employed a naturalistic study design, patients were not systematically randomized, there was no control group and patients received concurrent and partially changing medications during treatment.
Functional and Metabolic Changes in the Course of Antidepressive Treatment, https://clinicaltrials.gov/ct2/show/NCT02099630, NCT02099630.
虽然电休克疗法（ECT）被认为是治疗难治性抑郁症患者急性发作的金标准，但氯胺酮最近已成为这些患者的一种快速起效的治疗选择。疗效和起效时间目前是影响临床决策的主要因素，然而，鉴于抑郁症中的认知障碍与疾病负担和功能恢复密切相关，这些治疗对认知功能的影响也应是一个关键点。已知ECT会诱发短暂的认知障碍，而关于氯胺酮对认知的影响知之甚少。因此，本研究旨在比较ECT和连续氯胺酮给药在抗抑郁疗效以及急性神经认知效应方面的差异。
50名抑郁症患者接受了连续氯胺酮输注或ECT治疗。在治疗前、治疗期间和治疗后评估抑郁严重程度和认知功能。
ECT和氯胺酮给药同样有效，然而，氯胺酮的抗抑郁作用起效更快。氯胺酮改善了神经认知功能，尤其是注意力和执行功能，而ECT则导致认知表现总体略有下降。
由于其对认知的促进作用和更快的抗抑郁效果，连续氯胺酮给药可能是比ECT更有利的短期治疗选择。
由于本研究采用了自然主义研究设计，患者未进行系统随机分组，没有对照组，且患者在治疗期间接受了同时使用且部分有变化的药物治疗。
抗抑郁治疗过程中的功能和代谢变化，https://clinicaltrials.gov/ct2/show/NCT02099630，NCT02099630。
