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Ketamine as the anaesthetic for electroconvulsive therapy: The KANECT randomised controlled trial

  • Gordon Fernie (a1), James Currie (a2), Jennifer S. Perrin (a2), Caroline A. Stewart (a3), Virginica Anderson (a2), Daniel M. Bennett (a4), Steven Hay (a2) and Ian C. Reid (a4)...
  • Please note a correction has been issued for this article.
Abstract
Background

Ketamine has recently become an agent of interest as an acute treatment for severe depression and as the anaesthetic for electroconvulsive therapy (ECT). Subanaesthetic doses result in an acute reduction in depression severity while evidence is equivocal for this antidepressant effect with anaesthetic or adjuvant doses. Recent systematic reviews call for high-quality evidence from further randomised controlled trials (RCTs).

Aims

To establish if ketamine as the anaesthetic for ECT results in fewer ECT treatments, improvements in depression severity ratings and less memory impairment than the standard anaesthetic.

Method

Double-blind, parallel-design, RCT of intravenous ketamine (up to 2 mg/kg) with an active comparator, intravenous propofol (up to 2.5 mg/kg), as the anaesthetic for ECT in patients receiving ECT for major depression on an informal basis. (Trial registration: European Clinical Trials Database (EudraCT): 2011-000396-14 and clinicalTrials.gov: NCT01306760.)

Results

No significant differences were found on any outcome measure during, at the end of or 1 month following the ECT course.

Conclusions

Ketamine as an anaesthetic does not enhance the efficacy of ECT.

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Copyright
This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND) licence.
Corresponding author
Gordon Fernie, Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, 3rd Floor Health Services Building, Fosterhill, University of Aberdeen, Aberdeen AB25 2ZD, UK. Email: g.fernie@abdn.ac.uk
Footnotes
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*

Deceased.

Declaration of interest

C.AS. reports grants from Vifor Pharma, outside the submitted work. I.C.R. (deceased) declared personal fees from AstraZeneca, Sanofi Aventis and Sunovion, and non-financial support from Lundbeck, between 2009 and 2014 and all outside the submitted work.

Footnotes
References
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Ketamine as the anaesthetic for electroconvulsive therapy: The KANECT randomised controlled trial

  • Gordon Fernie (a1), James Currie (a2), Jennifer S. Perrin (a2), Caroline A. Stewart (a3), Virginica Anderson (a2), Daniel M. Bennett (a4), Steven Hay (a2) and Ian C. Reid (a4)...
  • Please note a correction has been issued for this article.
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eLetters

Response to Dr Berki

Gordon Fernie, Trial Manager, Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen
Caroline A. Stewart, Researcher, formerly University of Dundee
Virginica Anderson, Consultant Anaesthetist, NHS Grampian
Daniel M. Bennett, Psychiatrist and Honorary Senior Lecturer, NHS Grampian and the University of Aberdeen
James Currie, Psychiatrist, NHS Grampian
19 June 2017

Dear Dr Berki,

Thank you very much for your interest in our work. We regret that we cannot answer your question as we did not specify the collection of data on seizure length or quality as part of the trial - it was not one of the outcome measures specified in our protocol. Our primary aim was to investigate whether using ketamine as the anaesthetic for ECT improved depression symptoms and if it resulted in fewer treatments. We do not believe the lack of seizure length data limits our findings in this regard, although it’s reporting may have had added implications for the trial result. ... More

Conflict of interest: None Declared

Write a reply

Ketamine and seizure threshold.

Zafeer H Berki, Psychiatrist, Captain James A Lovell Federal Healthcare Center, North Chicago, Illinois
01 June 2017

Did the patients in Ketamine group show any difference in seizure induction or duration? If so then Ketamine may be more useful in patients who do not have adequate seizures during ECT.

Conflict of interest: None Declared

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