Ketamine as the anaesthetic for electroconvulsive therapy: the KANECT randomised controlled trial

Gordon Fernie; James Currie; Jennifer S. Perrin; Caroline A. Stewart; Virginica Anderson; Daniel M. Bennett; Steven Hay; Ian C. Reid

doi:10.1192/bjp.bp.116.189134

Ketamine as the anaesthetic for electroconvulsive therapy: the KANECT randomised controlled trial

Gordon Fernie (Lead / Corresponding author), James Currie, Jennifer S. Perrin, Caroline A. Stewart, Virginica Anderson, Daniel M. Bennett, Steven Hay, Ian C. Reid

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Abstract

Background: Ketamine has recently become an agent of interest as an acute treatment for severe depression and as the anaesthetic for electroconvulsive therapy (ECT). Subanaesthetic doses result in an acute reduction in depression severity while evidence is equivocal for this antidepressant effect with anaesthetic or adjuvant doses. Recent systematic reviews call for high-quality evidence from further randomised controlled trials (RCTs).

Aims: To establish if ketamine as the anaesthetic for ECT results in fewer ECT treatments, improvements in depression severity ratings and less memory impairment than the standard anaesthetic.

Method: Double-blind, parallel-design, RCT of intravenous ketamine (up to 2 mg/kg) with an active comparator, intravenous propofol (up to 2.5 mg/kg), as the anaesthetic for ECT in patients receiving ECT for major depression on an informal basis. (Trial registration: European Clinical Trials Database (EudraCT): 2011-000396-14 and clinicalTrials.gov: NCT01306760)

Results: No significant differences were found on any outcome measure during, at the end of or 1 month following the ECT course.

Conclusions: Ketamine as an anaesthetic does not enhance the efficacy of ECT.

Original language	English
Pages (from-to)	422-428
Number of pages	7
Journal	British Journal of Psychiatry
Volume	210
Issue number	6
Early online date	2 Mar 2017
DOIs	https://doi.org/10.1192/bjp.bp.116.189134
Publication status	Published - 1 Jun 2017

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© The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND) licence.
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Cite this

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title = "Ketamine as the anaesthetic for electroconvulsive therapy: the KANECT randomised controlled trial",

abstract = "Background: Ketamine has recently become an agent of interest as an acute treatment for severe depression and as the anaesthetic for electroconvulsive therapy (ECT). Subanaesthetic doses result in an acute reduction in depression severity while evidence is equivocal for this antidepressant effect with anaesthetic or adjuvant doses. Recent systematic reviews call for high-quality evidence from further randomised controlled trials (RCTs).Aims: To establish if ketamine as the anaesthetic for ECT results in fewer ECT treatments, improvements in depression severity ratings and less memory impairment than the standard anaesthetic.Method: Double-blind, parallel-design, RCT of intravenous ketamine (up to 2 mg/kg) with an active comparator, intravenous propofol (up to 2.5 mg/kg), as the anaesthetic for ECT in patients receiving ECT for major depression on an informal basis. (Trial registration: European Clinical Trials Database (EudraCT): 2011-000396-14 and clinicalTrials.gov: NCT01306760)Results: No significant differences were found on any outcome measure during, at the end of or 1 month following the ECT course.Conclusions: Ketamine as an anaesthetic does not enhance the efficacy of ECT.",

author = "Gordon Fernie and James Currie and Perrin, {Jennifer S.} and Stewart, {Caroline A.} and Virginica Anderson and Bennett, {Daniel M.} and Steven Hay and Reid, {Ian C.}",

note = "The Chief Scientists Office (CSO) of Scotland funded this research C.AS. reports grants from Vifor Pharma, outside the submitted work. I.C.R. (deceased) declared personal fees from AstraZeneca, Sanofi Aventis and Sunovion, and non-financial support from Lundbeck, between 2009 and 2014 and all outside the submitted work.",

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doi = "10.1192/bjp.bp.116.189134",

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AU - Fernie, Gordon

AU - Currie, James

AU - Perrin, Jennifer S.

AU - Stewart, Caroline A.

AU - Anderson, Virginica

AU - Bennett, Daniel M.

AU - Hay, Steven

AU - Reid, Ian C.

N1 - The Chief Scientists Office (CSO) of Scotland funded this research C.AS. reports grants from Vifor Pharma, outside the submitted work. I.C.R. (deceased) declared personal fees from AstraZeneca, Sanofi Aventis and Sunovion, and non-financial support from Lundbeck, between 2009 and 2014 and all outside the submitted work.

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Background: Ketamine has recently become an agent of interest as an acute treatment for severe depression and as the anaesthetic for electroconvulsive therapy (ECT). Subanaesthetic doses result in an acute reduction in depression severity while evidence is equivocal for this antidepressant effect with anaesthetic or adjuvant doses. Recent systematic reviews call for high-quality evidence from further randomised controlled trials (RCTs).Aims: To establish if ketamine as the anaesthetic for ECT results in fewer ECT treatments, improvements in depression severity ratings and less memory impairment than the standard anaesthetic.Method: Double-blind, parallel-design, RCT of intravenous ketamine (up to 2 mg/kg) with an active comparator, intravenous propofol (up to 2.5 mg/kg), as the anaesthetic for ECT in patients receiving ECT for major depression on an informal basis. (Trial registration: European Clinical Trials Database (EudraCT): 2011-000396-14 and clinicalTrials.gov: NCT01306760)Results: No significant differences were found on any outcome measure during, at the end of or 1 month following the ECT course.Conclusions: Ketamine as an anaesthetic does not enhance the efficacy of ECT.

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Ketamine as the anaesthetic for electroconvulsive therapy: the KANECT randomised controlled trial

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