Effects of propofol and ketamine as combined anesthesia for electroconvulsive therapy in patients with depressive disorder.

BACKGROUND: Electroconvulsive therapy (ECT) is a preferred therapy for major depressive disorder. Intravenous propofol, a sedative and hypnotic agent, is one of the choices of anesthetic for ECT. Ketamine, another anesthetic agent, providing sedation, amnesia, and analgesia, can also be used in patients undergoing ECT owing to its rapid action and persistent antidepressive effect. One adverse effect of ketamine is cardiovascular excitement, which may be reduced by propofol. Currently, the effects of combined anesthesia (propofol and ketamine) for patients with depressive disorder who have undergone ECT are unclear. The purpose of this study was to investigate the effects of the combined agents for patients undergoing ECT.

METHODS: Forty-eight patients with Hamilton Depression Rating Scale (HDRS) scores greater than 20 were randomly divided into 3 groups (n=16 each): propofol group (group P), ketamine group (group K), and propofol plus ketamine group (group PK). Propofol (1.5 mg/kg), ketamine (0.8 mg/kg), and propofol (1.5 mg/kg) plus ketamine (0.8 mg/kg) were infused to each group of patients, respectively, before ECT by an anesthesiologist with no knowledge of the HDRS score. For the purpose of this study, the patients received a single ECT treatment and were assessed for depression using the HDRS scores (1 day before ECT and days 1, 2, 3, and 7 after the ECT treatment) by a psychiatrist with no knowledge of the randomization group. After the final assessment, the patients received further treatment as needed up to 3 treatments per week. Seizure energy index, seizure duration, and adverse effects were observed during anesthesia by a nurse with no knowledge of the study group.

RESULTS: The HDRS scores improved earlier in group K and group PK. Decreases in HDRS scores were significantly greater in group K and group PK compared with those in group P. The adverse effects in group PK were fewer than those in group K. Seizure energy index and seizure duration in group K and group PK were higher and longer than those in group P during ECT.

CONCLUSION: The results suggested that propofol combined with ketamine anesthesia might be the first-choice anesthesia in patients with depressive disorder undergoing ECT.