Department of Psychiatry, Trivanta Medical and Neuro-psychiatry Hospital and Research Center, Udaipur, Rajasthan 313001, India.
Department of Psychiatry, Magna Centers for Obesity, Diabetes and Endocrinology, Bangalore, Karnataka 560076, India.
J Affect Disord. 2020 Nov 1;276:260-266. doi: 10.1016/j.jad.2020.07.066. Epub 2020 Jul 18.
To compare the antidepressant effects and cognitive adverse effects of intravenous ketamine infusion and Electro-convulsive therapy (ECT) in persons with severe depressive episodes.
This assessor-blinded randomized control trial included 25 patients (either sex; 18-65 years) meeting ICD-10 criteria for severe depression (bipolar or unipolar). Patients received either ECT (n = 13) or intravenous infusions of ketamine hydrochloride (0.5 mg/kg over 45 min; n = 12) for six alternate day sessions over a period of two weeks. Severity of depression was assessed at baseline and on every alternate day of intervention using the Hamilton Depression Rating Scale (HDRS) and self-reported Beck Depression Inventory (BDI).
Baseline socio-demographic and clinical variables including HDRS (ECT: 25.15±6.58; Ketamine: 23.33±4.05, p = 0.418) and BDI (ECT: 37.07±6.58; Ketamine: 33.33±9.29; p = 0.254) were comparable. Repeated-measures analysis of variance revealed that ECT patients showed significantly greater reduction in HDRS (grouptime interaction effect; F = 4.79; p<0.001) and BDI scores (grouptime interaction effect; F = 3.83; p<0.01). ECT patients had higher response rate than ketamine patients [HDRS: ECT- 13/13(100%) vs ketamine- 8/12 (66.70%); p = 0.04]. This was true for remission as well [ECT- 12/13(92.30%) vs ketamine- 6/12(50%), p = 0.030; both HDRS and BDI]. Performance on Digit Symbol Substitution Test (as part of the Battery for ECT-Related Cognitive Deficits scale) significantly improved in ketamine patients (p = 0.02) while that in ECT patients worsened non significantly (p = 0.30).
Relatively small sample size; higher proportion of dropouts in the Ketamine arm.
This study favoured ECT over ketamine for a better efficacy over six treatment sessions in severe depression. The results need to be replicated in larger studies.
CTRI/2019/09/021184.
比较静脉注射氯胺酮输注和电惊厥疗法（ECT）在重度抑郁发作患者中的抗抑郁作用和认知不良反应。
这项评估者盲法随机对照试验纳入了 25 名符合 ICD-10 重度抑郁（双相或单相）标准的患者（男女不限；18-65 岁）。患者接受 ECT（n=13）或静脉注射盐酸氯胺酮（0.5mg/kg，45 分钟；n=12），为期两周，每隔一天进行六次治疗。使用汉密尔顿抑郁评定量表（HDRS）和自我报告贝克抑郁量表（BDI）在基线和干预的每两天评估抑郁严重程度。
基线社会人口统计学和临床变量，包括 HDRS（ECT：25.15±6.58；氯胺酮：23.33±4.05，p=0.418）和 BDI（ECT：37.07±6.58；氯胺酮：33.33±9.29；p=0.254）均相似。重复测量方差分析显示，ECT 患者的 HDRS（组时间交互效应；F=4.79；p<0.001）和 BDI 评分显著降低（组时间交互效应；F=3.83；p<0.01）。ECT 患者的反应率高于氯胺酮患者[HDRS：ECT-13/13（100%）vs 氯胺酮-8/12（66.70%）；p=0.04]。缓解情况也是如此[ECT-12/13（92.30%）vs 氯胺酮-6/12（50%），p=0.030；HDRS 和 BDI 均如此]。氯胺酮患者的数字符号替代测试（作为与 ECT 相关认知缺陷量表的一部分）表现显著改善（p=0.02），而 ECT 患者的表现则非显著恶化（p=0.30）。
样本量相对较小；氯胺酮组的脱落率较高。
与六次治疗相比，这项研究在重度抑郁症中更倾向于 ECT 而非氯胺酮，因为 ECT 的疗效更好。这些结果需要在更大的研究中得到复制。
CTRI/2019/09/021184。
