Adjunctive ketamine in electroconvulsive therapy: updated systematic review and meta-analysis.

Abstract

<b>Background</b>Ketamine has emerged as a novel therapeutic agent for major depressive episodes, spurring interest in its potential to augment electroconvulsive therapy (ECT).<b>Aims</b>We sought to update our preliminary systematic review and meta-analysis, focusing on randomised controlled trials (RCTs) involving an index course of ECT, and testing the hypothesis that lack of efficacy is due to barbiturate anaesthetic co-administration.<b>Method</b>We searched EMBASE, CENTRAL and Medline to identify RCTs examining the efficacy of ketamine during a course of ECT. Data were synthesised from ten trials (ketamine group <i>n</i> = 333, comparator group <i>n</i> = 269) using pooled random effects models.<b>Results</b>Electroconvulsive therapy with ketamine was not associated with greater improvements in depressive symptoms or higher rates of clinical response or remission, nor did it result in pro-cognitive effects. This held true when limiting analysis to trials without barbiturate anaesthetic co-administration. Increased rates of confusion were reported.<b>Conclusions</b>Overall, our analyses do not support using ketamine over other induction agents in ECT.