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S -ketamine compared to etomidate during electroconvulsive therapy in major depression

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Abstract

Objective of the study was to compare two commonly used anesthetic drugs, S-ketamine and etomidate, regarding their influence on seizure characteristics, safety aspects, and outcome of electroconvulsive therapy (ECT) in major depression. Treatment data of 60 patients who underwent a total number of 13 ECTs (median) because of the severe or treatment-resistant major depressive disorder (DSM-IV) were analyzed. Etomidate, mean dosage (SD) = 0.25 (0.04) mg/kg, was used for anesthesia in 29 participants; 31 patients received S-ketamine, mean dosage (SD) = 0.96 (0.26) mg/kg. Right unilateral brief pulse ECTs were performed. The number of ECTs was individually adjusted to clinical needs, mean (SD) = 13.0 (4.3). Seizure characteristics, adverse events, and the clinical global impression (CGI) scores were compared between the both groups during ECT series. In the S-ketamine group, a lower initial seizure threshold (p = 0.014), stimulation charge (p < 0.001), higher postictal suppression (p < 0.001), EEG ictal amplitude (p = 0.04), EEG coherence (p < 0.001) and maximum heart rate (p = 0.015) were measured. Etomidate was associated with more frequent abortive seizures (p = 0.02) and restimulations (p = 0.01). The CGI scores, the number of sessions within an ECT series, and the incidence of adverse events did not differ between groups. Due to its lower initial seizure threshold, S-ketamine might hold a potential to become a clinically favorable anesthetic agent during ECT. However, the current findings should be interpreted with caution, and further prospective randomized clinical trials are required. Also, specific adverse effects profile of S-ketamine, especially with regard to the cardiovascular risk, needs to be taken into account.

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Acknowledgements

The work was in part supported by the German Research Foundation DFG FOR 2107 (Grant Nos. KI 588/14-1, DA 1151/5-1, KO 4291/3-1), University Medical Center Giessen and Marburg (Grand No. 27/2015 MR) and Rhön Klinikum AG (Grand No. FI22). Parts of this work were incorporated into a doctoral thesis of BK. The authors would like to acknowledge the work of all physicians and nurses of Department of Psychiatry and Psychotherapy at Marburg University who were involved in the electroconvulsive treatment.

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Correspondence to Maxim Zavorotnyy.

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MZ received financial support for educational program from Lundbeck, Servier, Actelion, MagVenture, Mag and More, Localite, Inomed, Sooma Oy, Brainsway/Tolko and NeuroConn. CK received fees for an educational program from Aristo Pharma, Lilly, Servier, and MagVenture, as well as travel support and speaker’s honoraria from Lundbeck, Janssen and Servier. However, it did not influence the content of this manuscript. All other authors report no financial or other relationship relevant to the subject of this article.

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Zavorotnyy, M., Kluge, I., Ahrens, K. et al. S -ketamine compared to etomidate during electroconvulsive therapy in major depression. Eur Arch Psychiatry Clin Neurosci 267, 803–813 (2017). https://doi.org/10.1007/s00406-017-0800-3

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