From the Department of Anesthesiology, School of Medicine, Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Behavioral Sciences Research Center, Department of Psychiatry, School of Medicine.
J Clin Psychopharmacol. 2020 Nov/Dec;40(6):588-593. doi: 10.1097/JCP.0000000000001289.
PURPOSE/BACKGROUND: This study was devised to compare the antidepressant and antisuicidal effects of oral and intramuscular (IM) ketamine versus electroconvulsive therapy (ECT).
METHODS/PROCEDURES: In our pilot study, 45 patients with major depressive disorder (based on Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria) in the age range of 18 to 70 years who were determined suitable candidates for ECT got randomly divided into 3 equal groups. Each group received one of these treatment modalities: 0.5 mg/kg of IM ketamine; 1 mg/kg of oral ketamine; and ECT in 6 to 9 sessions during 3 weeks. Depression and suicidal ideation scores were recorded using the Hamilton Depression Rating Scale and the Beck Scale for Suicidal Ideation, respectively, at baseline, 24 hours, 1 week, 2 weeks, and 3 weeks within the intervention. The measurements were repeated 1 week and 1 month after the end of the intervention as well. Vital signs and adverse effects were noted. Finally, satisfaction levels of patients for each method were recorded and compared between groups.
FINDINGS/RESULTS: The Hamilton Depression Rating Scale and the Beck Scale for Suicidal Ideation scores significantly improved in all groups compared with baseline with no significant differences between the 3 groups. The adverse effects for ketamine-consuming groups such as dissociative symptoms were brief and transient, whereas memory loss for the ECT group remained up to 1 month in some patients. Ketamine-receiving groups preferred it more than ECT.
IMPLICATIONS/CONCLUSIONS: Oral and IM ketamine probably have equal antidepressant in addition to more antisuicidal effects compared with ECT but had less cognitive adverse effects and higher preference by patients. Thereby, ketamine can be an alternative method in the treatment of patients with severe and/or suicidal MDD.
目的/背景：本研究旨在比较口服和肌肉注射（IM）氯胺酮与电惊厥疗法（ECT）的抗抑郁和抗自杀效果。
方法/程序：在我们的初步研究中，将 45 名年龄在 18 至 70 岁之间的符合重性抑郁障碍（基于精神障碍诊断与统计手册第五版标准）的患者随机分为 3 组，每组患者均接受以下治疗方式之一：0.5mg/kg 的 IM 氯胺酮；1mg/kg 的口服氯胺酮；以及在 3 周内进行 6 至 9 次 ECT。在干预开始时、24 小时、1 周、2 周和 3 周时，使用汉密尔顿抑郁评定量表和贝克自杀意念量表分别记录抑郁和自杀意念评分。在干预结束后 1 周和 1 个月时，再次进行了测量。同时还记录了生命体征和不良反应。最后，记录了每位患者对每种方法的满意度并进行了组间比较。
结果/发现：与基线相比，所有组的汉密尔顿抑郁评定量表和贝克自杀意念量表评分均显著改善，3 组之间无显著差异。氯胺酮组出现分离症状等不良反应短暂且短暂，而 ECT 组的一些患者记忆丧失持续到 1 个月。氯胺酮组比 ECT 组更受患者青睐。
意义/结论：与 ECT 相比，口服和 IM 氯胺酮可能具有同等的抗抑郁作用，此外还有更强的抗自杀作用，但认知不良反应较少，患者更倾向于使用。因此，氯胺酮可以作为治疗严重和/或有自杀倾向的 MDD 患者的替代方法。
