Efficacy and adverse effects of ketamine versus electroconvulsive therapy for major depressive disorder: A systematic review and meta-analysis.
Efficacy and adverse effects of ketamine versus electroconvulsive therapy for major depressive disorder: A systematic review and meta-analysis.
复制标题
氯胺酮与电休克疗法治疗重度抑郁症的疗效和不良反应：系统评价和荟萃分析。
DOI：
10.1016/j.jad.2023.02.152
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发表时间：
2023
影响因子：
6.6
通讯作者：
Quevedo,João
中科院分区：
文献类型：
--
作者：
deASimoesMoreira,Debora;Gauer,LuísEduardo;Teixeira,Guilherme;FonsecadaSilva,AmandaCarolina;Cavalcanti,Stefanie;Quevedo,João
研究背景ECT被认为是治疗TRD最快、最有效的方法。氯胺酮似乎是一个有吸引力的替代品，由于其快速起效的抗抑郁作用和对自杀念头的影响。本研究的目的是比较ECT和氯胺酮的疗效和耐受性不同的抑郁症的结果（PROSPERO/CRD 42022349220）。MethodsWe搜索MEDLINE，Web of Science，Embase，PsycINFO，谷歌学术，科克伦图书馆和试验注册处，这是ClinicalTrials.gov和世界卫生组织的国际临床试验注册平台，没有限制的出版日期。选择标准：随机对照试验或队列比较氯胺酮与ECT患者TRD.ResultsEight研究符合纳入标准（2875检索）。进行了比较氯胺酮和ECT以下结局的随机效应模型：a）通过量表降低抑郁症状严重程度，g =-0.12，p = 0.68; B）对治疗的反应，RR = 0.89，p = 0.51; c）报告的副作用：分离症状，RR = 5.41，p = 0.06;恶心，RR = 0.73，p = 0.47;肌肉疼痛，RR = 0.25，p = 0.02;头痛，RR = 0.39，p = 0.08。Influential & subgroup analyses were performed.LimitationsMethodological issues with high risk of bias in some of the source material，reduced number of eligible studies with high in-between heterogeneity and small sample sizes.ConclusionOur study showed no evidence to support the superior of ketamine over ECT for severe depression symptoms and response to therapy.关于副作用，与ECT相比，氯胺酮治疗患者的肌肉疼痛风险在统计学上显著降低。
BackgroundECT is considered the fastest and most effective treatment for TRD. Ketamine seems to be an attractive alternative due to its rapid-onset antidepressant effects and impact on suicidal thoughts. This study aimed to compare efficacy and tolerability of ECT and ketamine for different depression outcomes (PROSPERO/CRD42022349220).MethodsWe searched MEDLINE, Web of Science, Embase, PsycINFO, Google Scholar, Cochrane Library and trial registries, which were the ClinicalTrials.gov and the World Health Organization's International Clinical Trials Registry Platform, without restrictions on publication date. Selection criteria: randomized controlled trials or cohorts comparing ketamine versus ECT in patients with TRD.ResultsEight studies met the inclusion criteria (of 2875 retrieved). Random-effects models comparing ketamine and ECT regarding the following outcomes were conducted: a) reduction of depressive symptoms severity through scales, g = −0.12, p = 0.68; b) response to therapy, RR = 0.89, p = 0.51; c) reported side-effects: dissociative symptoms, RR = 5.41, p = 0.06; nausea, RR = 0.73, p = 0.47; muscle pain, RR = 0.25, p = 0.02; and headache, RR = 0.39, p = 0.08. Influential & subgroup analyses were performed.LimitationsMethodological issues with high risk of bias in some of the source material, reduced number of eligible studies with high in-between heterogeneity and small sample sizes.ConclusionOur study showed no evidence to support the superiority of ketamine over ECT for severity of depressive symptoms and response to therapy. Regarding side effects, there was a statistically significant decreased risk of muscle pain in patients treated with ketamine compared to ECT.