Drug allocation was according to patient preference in discussion with the anaesthetist. Those anaesthetized with ketamine showed statistically significantly improvements in HDRS scores compared with those who received propofol after the second (p < 0.001) and fourth sessions (p < 0.001) but not after the sixth (p = 0.086) or eighth (p = 0.360) sessions. The retrospective study by Kranaster and colleagues evaluated the records of 42 patients with TRD who had ECT anaesthetised with either ketamine (n = 16) or thiopental (n = 26), and those treated with ketamine needed significantly fewer ECT sessions (p = 0.015),
had lower HAMD scores (p = 0.015) and, contrary to the negative (although Inhibitors,research,lifescience,medical Inhibitors,research,lifescience,medical more thorough assessment battery) neuropsychological tests noted in the study by Loo and colleagues [Loo et al. 2012], had higher Mini Mental State Examination (MMSE)
scores (p = 0.025) [Kranaster et al. 2011]. Depression severity was similar in both groups prior to treatment, and needing fewer ECT sessions was taken as an implicit marker of positive outcome, although with the obvious caveats in interpreting retrospective data collection. Inhibitors,research,lifescience,medical However, the ketamine group also needed more anaesthetic interventions to manage raised blood pressure. Surgical use of ketamine as an anaesthetic in different depressed patients A single study [Kudoh et al. 2002] evaluated the antidepressant effects of ketamine when used as a general anaesthetic (combined with propofol and fentanyl, n = 35) compared with combined propofol and fentanyl (n = 35)
on 70 depressed patients undergoing orthopaedic surgery. A control group of 25 nondepressed Inhibitors,research,lifescience,medical patients received the three-drug combination. In the depressed www.selleckchem.com/products/Tubacin.html cohort those receiving ketamine as part of their anaesthesia showed statistically significant improvement in their mood measured by the HDRS (p < 0.05) one day after surgery; interestingly the ketamine group also showed a significant reduction in post-operative pain scores (p < 0.05), which the authors highlight is a noted Inhibitors,research,lifescience,medical complication of surgery in depressed patients. The control group showed no change in their mental state. Discussion Ketamine’s efficacy as an antidepressant In total, 22 RCTs Entinostat and non-RCTs were identified that investigated the potential role of ketamine as an antidepressant in MDD and BPAD, totalling 629 participants. Ketamine infusion resulted in a rapid antidepressant effect in the vast majority of the presented studies, either administered alone, with an augmenter, or in combination with ECT. Furthermore, several recent studies demonstrated a rapid antisuicidal effect that was independent of antidepressant response. High response rates were documented in many studies, with three of the included RCTs recording a 71–79% response rate at 24 hours post-ketamine infusion [DiazGranados et al. 2010b; Zarate et al. 2006, 2012].
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