C. Michael White, University of Connecticut – Ketamine and Electroconvulsive Therapy

Depression sufferers may have a new choice for treatment.

C. Michael White, distinguished professor and chair of pharmacy practice at the University of Connecticut School of Pharmacy, explains.

Michael White, Pharm.D., FCP, FCCP, FASHP has ~500 publications resulting in 18288 citations with an H-index of 70; placing him within an elite group of researchers. Dr. White’s research interests are in the areas of comparative effectiveness and preventing adverse events from drugs, devices, dietary supplements, and illicit substances. His work has been published in JAMA, Lancet, Annals of Internal Medicine and Circulation (among others) with research coverage by NBC News, Good Morning America, BBC, CNN, NY Times, Washington Post, LA Times, Boston Globe, PBSNewsHour, WNPR Morning Edition, Prevention Magazine, and hundreds of other (inter)national media outlets. He has received the American College of Clinical Pharmacist Young Investigator Award, American Society of Health-System Pharmacists Award for Sustained Contributions to the Literature and the Drug Therapy Research Award, and the American Association of Colleges of Pharmacy Lyman Award and the Weaver Award.

Ketamine and Electroconvulsive Therapy

Most antidepressant therapies take weeks to start working but some patients have such severe symptoms, they do not have time to wait. There are only two options for quicker relief of severe depression symptoms and suicidal thoughts. The most effective option is electroconvulsive therapy, also called ECT, where patients are put under anesthesia and then their brains are shocked with electricity. The other option is ketamine, an anesthesia agent that treats depression through its unique dissociative effects. Both options are given repeatedly to patients a few times a week for a couple of weeks. We wondered if combining ketamine with ECT would provide more benefits than using traditional anesthesia agents such as propofol, methohexital, or thiopentone with ECT. We found seventeen trials with almost 1,200 patients who received either ketamine or another anesthesia agent with their ECT and conducted a meta-analysis of their results. Patients receiving ketamine anesthesia were 78% more likely to achieve clinical remission by the end of trials than those receiving another anesthesia drug and better reductions in depression symptom scores were evident as early as the third ECT session. However, ketamine anesthesia was associated with more side effects when people initially regained consciousness after ECT, including more fear with hallucinations, delirium, and high blood pressure but these effects quickly resolved. As the old adage says, “If you can beat ‘em, join ‘em”.  Clinical trial results suggest that patients who have tried ECT with regular anesthesia but did not get enough benefit could achieve additional benefits by switching to ketamine as the anesthesia drug before ECT but could have some additional side effects.  

Read More:
[Sage Journals] – The Impact of Ketamine-Based Versus Non-Ketamine-Based ECT Anesthesia Regimens on the Severity of Patients’ Depression and Occurrence of Adverse Events: A Systematic Review with Meta-Analysis