University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands; PsyQ Haaglanden, Parnassia Psychiatric Institute, The Hague, the Netherlands.
University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands.
J Affect Disord. 2021 Feb 15;281:82-89. doi: 10.1016/j.jad.2020.11.123. Epub 2020 Nov 30.
Ketamine has repeatedly shown to have rapid and robust antidepressant effects in patients with treatment resistant depression (TRD). An important question is whether ketamine is as effective and safe as the current gold standard electroconvulsive therapy (ECT).
The literature was searched for trials comparing ketamine treatment with ECT for depression in the Pubmed/MEDLINE database and Cochrane Trials Library.
A total of 137 manuscripts were identified, 6 articles were included in this review. Overall quality of the included studies was diverse with relevant risk of bias for some of the studies. Results suggest that ketamine treatment might give faster but perhaps less durable antidepressant effects. Side effects differed from ECT, in particular less cognitive impairment was apparent in ketamine treatment.
The included studies have limited sample sizes, use different treatment protocols and in most trials, longer term follow up is lacking. Furthermore, allocation bias appears likely in the non-randomized trials.
Current available literature does not yet provide convincing evidence to consider ketamine as an equally effective treatment alternative to ECT in patients with TRD. There are indications for a more favourable short term cognitive side effect profile after ketamine treatment. Methodologically well-designed studies with larger sample sizes and longer follow up duration are warranted.
氯胺酮已多次显示出对治疗抵抗性抑郁症（TRD）患者具有快速而强大的抗抑郁作用。一个重要的问题是，氯胺酮是否与当前的金标准电惊厥疗法（ECT）一样有效和安全。
在 Pubmed/MEDLINE 数据库和 Cochrane 临床试验图书馆中搜索比较氯胺酮治疗与 ECT 治疗抑郁症的试验文献。
共确定了 137 篇手稿，其中 6 篇文章被纳入本综述。纳入研究的总体质量参差不齐，一些研究存在相关的偏倚风险。结果表明，氯胺酮治疗可能会更快地产生抗抑郁作用，但可能持续时间较短。副作用与 ECT 不同，特别是氯胺酮治疗中认知障碍较少。
纳入的研究样本量有限，使用不同的治疗方案，并且在大多数试验中，缺乏长期随访。此外，非随机试验中似乎存在分配偏倚。
目前的可用文献尚未提供令人信服的证据，表明氯胺酮在治疗 TRD 患者时可作为 ECT 的等效有效治疗选择。氯胺酮治疗后短期认知副作用的情况可能更有利。需要进行设计方法更完善、样本量更大且随访时间更长的研究。
