Mood and neuropsychological effects of different doses of ketamine in electroconvulsive therapy for treatment-resistant depression
Mood and neuropsychological effects of different doses of ketamine in electroconvulsive therapy for treatment-resistant depression
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不同剂量氯胺酮对难治性抑郁症电休克治疗中情绪和神经心理的影响
DOI：
10.1016/j.jad.2016.05.011
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发表时间：
2016-09-01
影响因子：
6.6
通讯作者：
Huang, Xiong
中科院分区：
文献类型：
--
作者：
Zhong, Xiaomei;He, Hongbo;Huang, Xiong
背景：难治性抑郁症（TRD）是一个日益增长的临床挑战。电休克治疗（ECT）是治疗TRD的有效工具。然而，仍有一部分患者对普通麻醉剂治疗无反应。氯胺酮，一个值得注意的麻醉剂，已成为一个增强，以提高抗抑郁疗效的ECT。静脉注射氯胺酮治疗TRD的试验表明了剂量相关的情绪增强疗效。我们的目的是探讨氯胺酮在ECT治疗TRD中的麻醉和亚麻醉浓度对情绪和神经心理学效应的影响。男36人，女54人;平均年龄30.6岁）随机分配接受氯胺酮或（0.8 mg/kg）（n=30）、亚麻醉氯胺酮（0.5 mg/kg）+丙泊酚（0.5 mg/kg）（n=30）或丙泊酚（0.8 mg/kg）（n=30）作为麻醉剂，并进行8次ECT治疗。主要结果指标为17项汉密尔顿抑郁量表（HDRS-17）、认知功能评估和癫痫发作参数。结果：氯胺酮组HDRS-17改善较早，癫痫发作持续时间较长，电活动量较低，缓解率较高，执行认知功能损害程度较低。与丙泊酚组相比，氯胺酮+丙泊酚组HDRS-17改善更早，癫痫发作持续时间更长，癫痫发作能量指数不同。局限性：未评估术后分离性副作用。麻醉和亚麻醉浓度的氯胺酮在ECT治疗TRD中均具有快速的情绪增强作用，而麻醉剂浓度导致更大程度的抗抑郁和认知保护。ECT联合氯胺酮麻醉可能是TRD患者的最佳治疗方法。(C)2016爱思唯尔B. V.保留所有权利。
Background: Treatment-resistant depression (TRD) is a growing clinical challenge. Electroconvulsive therapy (ECT) is an effective tool for TRD treatment. However, there remains a subset of patients who do not respond to this treatment with common anesthetic agent. Ketamine, a noteworthy anesthetic agent, has emerged as an augmentation to enhance the antidepressant efficacy of ECT. Trials of i.v. ketamine in TRD indicated dose-related mood enhancing efficacy. We aimed to explore anesthetic and subanesthetic concentrations of ketamine in ECT for TRD with respect to their impact on mood and neuropsychological effects.Methods: Ninety TRD patients (36 males, 54 females; average age, 30.6 years old) were randomly assigned to receive either ketamine (0.8 mg/kg) (n=30), subanesthetic ketamine (0.5 mg/kg) plus propofol (0.5 mg/kg) (n=30) or propofol (0.8 mg/kg) (n=30) as an anesthetic and underwent 8 ECT sessions. The primary outcome measures were the 17-item Hamilton Depression Rating Scale (HDRS-17), cognitive assessments and seizure parameters.Results: The ketamine group had an earlier improvement in HDRS-17, longer seizure duration, lower electric quantity, a higher remission rate, and a lower degree of executive cognitive impairment compared to the ketamine + propofol and propofol groups. The ketamine + propofol group showed earlier improvement in the HDRS-17, a longer seizure duration and a different seizure energy index when compared to the propofol group.Limitations: The postoperative dissociative side effect was not assessed.Conclusions: Both anesthetic and subanesthetic concentrations of ketamine have rapid mood enhancing actions in ECT for TRD, while anesthetic concentrations results in larger magnitudes of antidepression and cognitive protection. ECT with ketamine anesthesia might be an optimized therapy for patients with TRD. (C) 2016 Elsevier B.V. All rights reserved.