Ketamine and electroconvulsive therapy

Cobb, Kathryn; Nanda, Monika

doi:10.1097/aco.0000000000000607

Cited by 7 publications

(5 citation statements)

References 26 publications

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Section: Discussionmentioning

confidence: 99%

“…13,14 Cobb and Nanda note a lack of high-quality evidence to suggest that ECT with ketamine is superior to ECT with other anaesthetic agents, and they also report limited evidence regarding the superiority of the direct effects of ketamine on depression when compared to ECT. 10 There are a few case reports of liver dysfunction associated with regular recreational ketamine use in HIV-positive men on ART, specifically ritonavir-containing regimes. 20 Ketamine is metabolised primarily by CYP2B6, as well as CYP3A4 and CYP2C9.…”

Section: Discussionmentioning

confidence: 99%

“…The use of ketamine as the first-line choice of induction agent for ECT is theoretically limited due to its side effect profile, which can include dissociative properties, with the occurrence of dose-dependent perceptual disturbances and delirium-like states on emergence from anaesthesia, as well as concerns around increasing the risk of arrythmias. 10 However, ketamine has been used successfully in anaesthesia for ECT, with noted improved seizure duration, and has been well tolerated. 11 , 12 There are also a few case reports suggesting that ketamine may be also an effective alternative treatment for catatonia.…”

Section: Introductionmentioning

confidence: 99%

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Electroconvulsive therapy (ECT) with ketamine induction for catatonia in an HIV positive patient

Nel

Bracken

2023

South African Journal of Psychiatry

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Introduction: The successful use of ECT as treatment for catatonia, in the context of HIV (human immunodeficiency virus) infection, has been described previously. Ketamine has been used as an anaesthetic induction agent for ECT, although not considered the induction agent of choice. There are also case reports suggesting that ketamine may be an alternative treatment specifically for catatonia.Patient presentation: This case report describes the management of a female patient who presented with catatonia, evidenced by stupor, waxy flexibility, mutism, negativism, and stereotypy, as well as stage four HIV infection, with poor response to previous psychotherapeutic interventions.Management and outcome: We describe the course of management of this patient with ECT, following poor initial clinical response to ECT with propofol induction, the subsequent use of ketamine as an anaesthetic induction agent for ECT, with associated improvement in seizure quality, and good overall clinical response to ECT demonstrated thereafter.Conclusion and contributions: This case report suggests that ketamine may be a viable induction agent for ECT in this clinical setting.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Electroconvulsive therapy (ECT) with ketamine induction for catatonia in an HIV positive patient

Nel

Bracken

2023

South African Journal of Psychiatry

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“…It has been postulated that ketamine, due to its anesthetic and anti-depressive effects, could be the ideal anesthetic for use in ECT. However, at this time there is a lack of sufficient evidence that demonstrates that ECT in conjunction with ketamine as an anesthetic is more efficacious than using typical anesthetics during ECT to treat depression [ 12 , 13 ]. Alternatively, ketamine alone has been shown to have an antidepressant effect within 40 minutes of administration with a single intravenous (IV) infusion in those with MDD, with maximum efficacy occurring at 24 hours post-infusion.…”

Section: Reviewmentioning

confidence: 99%

The Therapeutic Effects of Ketamine in Mental Health Disorders: A Narrative Review

Ramos¹,

Thornburg²,

Long³

et al. 2022

Cureus

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Ketamine, a non-competitive N-methyl-d-aspartate receptor antagonist, is commonly used as an anesthetic and analgesic but has recently shown promising research in treating certain psychiatric conditions such as depression, post-traumatic stress disorder (PTSD), suicidal ideation, and substance use disorder. Due to its euphoric, dissociative, and hallucinogenic properties, ketamine has been abused as a recreational drug, which has led to rigid regulation of medication. The COVID-19 pandemic has been an unprecedented challenge for the American population which was reflected in increased reports of problems regarding their mental health. Mood disorders have dramatically increased in the past two years. Approximately one in ten people stated that they had started or increased substance use because of the COVID-19 pandemic. Furthermore, rates of suicidal ideation have significantly increased when compared to pre-pandemic levels, with more than twice the number of adults surveyed in 2018 indicating suicidal thoughts “within the last 30 days” at the time they were surveyed. Moreover, many responders indicated they had symptoms of PTSD. The PubMed database was searched using the keyword “ketamine,” in conjunction with “depression,” “suicidal ideation,” “substance use disorder,” and “post-traumatic stress disorder.” The inclusion criteria encompassed articles from 2017 to 2022 published in the English language that addressed the relationship between ketamine and mental health disorders. With this sharp increase in the prevalence of psychiatric disorders and an increased public interest in mental health combined with the promise of the therapeutic value of ketamine for certain mental health conditions, including suicidal ideation, this narrative review sought to identify recently published studies that describe the therapeutic uses of ketamine for mental health. Results of this review indicate that ketamine’s therapeutic effects offer a potential alternative treatment for depression, suicidal ideation, substance use disorders, and PTSD.

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“…Through the intramuscular route, anesthesia develops within 10–15 min and typically lasts for 30–120 min. In adults, a typical intramuscular dose is 6.5 to 13 mg/kg in adults, whereas a typical intravenous induction dose is 1 to 2 mg/kg [ 18 , 19 ]. These properties of ketamine are summarized in Table 1 .…”

Section: Anesthetic Drugs Currently Used During Ectmentioning

confidence: 99%

A Narrative Overview of Current Anesthetic Drugs in Electroconvulsive Therapy

Lee

Jenkins

Sparkle

2021

Life

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Electroconvulsive therapy (ECT) is a definitive treatment for patients with psychiatric disorders that are severe, acute, or refractory to pharmacologic therapy. Providing anesthesia for ECT is challenging, as the effect of drugs on hemodynamics, seizure duration, comfort, and recovery must be considered. We highlight and aim to review the common anesthetics used in ECT and related evidence. While drugs such as methohexital, succinylcholine, and etomidate have been used in the past, other drugs such as dexmedetomidine, ketamine, and remifentanil may provide a more balanced anesthetic with a greater safety profile in select populations. Overall, it is essential to consider the patient’s co-morbidities and associated risks when deciding on an anesthetic drug.

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Ketamine and electroconvulsive therapy

Cited by 7 publications

References 26 publications

Electroconvulsive therapy (ECT) with ketamine induction for catatonia in an HIV positive patient

Electroconvulsive therapy (ECT) with ketamine induction for catatonia in an HIV positive patient

The Therapeutic Effects of Ketamine in Mental Health Disorders: A Narrative Review

A Narrative Overview of Current Anesthetic Drugs in Electroconvulsive Therapy

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