한빛사논문
- 조회374
Taeho Greg Rhee 1,2,3,13, Sung Ryul Shim4,13, Jonah H. Popp5, Thomas A. Trikalinos5, Robert A. Rosenheck1,2, Charles H. Kellner6, Stephen J. Seiner7,8, Randall T. Espinoza9, Brent P. Forester7,8,10 and Roger S. McIntyre11,12
1Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA.
2VA New England Mental Illness, Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, West Haven, CT, USA.
3Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, CT, USA.
4Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Chungcheongnam-do, Republic of Korea.
5Center for Evidence Synthesis in Health, Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA.
6Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
7Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
8Division of Neurotherapeutics, McLean Hospital, Belmont, MA, USA.
9Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, CA, USA.
10Department of Psychiatry, Tufts University School of Medicine, Boston, MA, USA.
11Brain and Cognition Discovery Foundation, Toronto, ON, Canada. 12Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
13These authors contributed equally: Taeho Greg Rhee, Sung Ryul Shim.
These authors contributed equally: Taeho Greg Rhee, Sung Ryul Shim
Corresponding author : Correspondence to Taeho Greg Rhee.
Abstract
Objective: To meta-analyze clinical efficacy and safety of ketamine compared with other anesthetic agents in the course of electroconvulsive therapy (ECT) in major depressive episode (MDE).
Methods: PubMed/MEDLINE, Cochrane Library, Embase, GoogleScholar, and US and European trial registries were searched from inception through May 23, 2023, with no language limits. We included RCTs with (1) a diagnosis of MDE; (2) ECT intervention with ketamine and/or other anesthetic agents; and (3) measures included: depressive symptoms, cognitive performance, remission or response rates, and serious adverse events. Network meta-analysis (NMA) was performed to compare ketamine and 7 other anesthetic agents. Hedges' g standardized mean differences (SMDs) were used for continuous measures, and relative risks (RRs) were used for other binary outcomes using random-effects models.
Results: Twenty-two studies were included in the systematic review. A total of 2322 patients from 17 RCTs were included in the NMA. The overall pooled SMD of ketamine, as compared with propofol as a reference group, was -2.21 (95% confidence interval [CI], -3.79 to -0.64) in depressive symptoms, indicating that ketamine had better antidepressant efficacy than propofol. In a sensitivity analysis, however, ketamine-treated patients had a worse outcome in cognitive performance than propofol-treated patients (SMD, -0.18; 95% CI, -0.28 to -0.09). No other statistically significant differences were found.
Conclusions: Ketamine-assisted ECT is tolerable and may be efficacious in improving depressive symptoms, but a relative adverse impact on cognition may be an important clinical consideration. Anesthetic agents should be considered based on patient profiles and/or preferences to improve effectiveness and safety of ECT use.
논문정보
- Research article
- 2023년 12월 (BRIC 등록일 2023-12-22)
- 국내+국외 연구진
- 의약학 > 신경의학
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