The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China.
School of Acupuncture-Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine, Jinan, China.
J Psychiatr Res. 2024 Jul;175:218-226. doi: 10.1016/j.jpsychires.2024.05.022. Epub 2024 May 11.
Ketamine, electroconvulsive therapy (ECT), and their combination are effective for treating severe depression, but few large-scale studies have compared these.
We searched databases for randomized controlled trials (RCTs) using ketamine, ECT, ketamine + ECT, or placebo for severe depression. Standardized measures were efficacy outcomes. Risk of bias was assessed. Stata and ADDIS were used for network meta-analysis (NMA) comparing efficacy and adverse reactions post-treatment. This study was registered on PROSPERO (CRD42023476740).
17 RCTs with 1370 patients were included. NMA showed ECT and ketamine improved Hamilton Depression Rating Scale (HDRS) versus placebo; other comparisons not significant. Rank probabilities showed highest probability for ECT, followed by ketamine + ECT, ketamine, placebo. No differences in Montgomery-Asberg Depression Rating Scale (MADRS); highest rank probability again for ECT, followed by ketamine + ECT, ketamine, placebo.
Analysis suggests ECT superior to ketamine and their combination for improving depressive severity, but individualized treatment selection warranted. Higher adverse reactions with ketamine + ECT need further study for optimized combined use.
氯胺酮、电抽搐疗法（ECT）及其联合应用对治疗重度抑郁症有效，但很少有大规模研究对其进行比较。
我们检索了氯胺酮、ECT、氯胺酮+ECT 或安慰剂治疗重度抑郁症的随机对照试验（RCT）的数据库。采用标准化措施评估疗效。采用 Stata 和 ADDIS 进行网络荟萃分析（NMA），比较治疗后疗效和不良反应。本研究在 PROSPERO（CRD42023476740）上注册。
纳入了 17 项 RCT，共 1370 例患者。NMA 显示 ECT 和氯胺酮改善了汉密尔顿抑郁量表（HDRS）与安慰剂相比；其他比较无显著差异。秩概率显示 ECT 最高，其次是氯胺酮+ECT、氯胺酮、安慰剂。蒙哥马利-阿斯伯格抑郁评定量表（MADRS）无差异；ECT 最高，其次是氯胺酮+ECT、氯胺酮、安慰剂。
分析表明 ECT 优于氯胺酮及其联合应用，可改善抑郁严重程度，但需要个体化治疗选择。氯胺酮+ECT 的不良反应更高，需要进一步研究以优化联合应用。
