Effect of ketamine, thiopental and ketamine–thiopental combination during electroconvulsive therapy for depression

Objective: We aimed to evaluate the effect of anaesthesia with thiopental (4 mg kg-1), ketamine (1 mg kg-1) and ketamine-thiopental (1 mg kg-1 and 4 mg kg-1, respectively) combination during electroconvulsive therapy (ECT) on the Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HAM-A) and haemodynamic variables in patients with resistant major depression. Methods: Patients with HDRS scores above 17 were included. The patients were randomly divided into three groups according to the anaesthesia used. Group 1 was given thiopental (4 mg kg-1), Group 2 was given ketamine (1 mg kg-1) and Group 3 was given ketamine (1 mg kg-1) and thiopental (4 mg kg-1). Succinylcholine (1 mg kg-1) was administered in all patients for muscle relaxation. HDRS and HAM-A scores were evaluated before ECT, after 3, 6. ECT and after the final ECT. Systolic and diastolic blood pressures, heart rates and oxygen saturations were recorded before and after anaesthesia induction and after the ECT procedure. Seizure duration was recorded. Results: Fifty-eight patients were included in the study. Thirty (52%) patients were male and 28 (48%) were female. The mean age was 42.7±15.8 years in Group 1, 44.8±11 years in Group 2 and 38.6±6.8 years in Group 3. In all groups, HDRS scores were reduced compared with the baseline values. There was no statistical significant difference between the groups regarding HDRS scores. HAM-A scores were higher in Group 2 and Group 3. Systolic and diastolic blood pressures and heart rate values were lower in Group 1 and the difference was statistically significant. Conclusion: In this study, anaesthesia induced with thiopental, ketamine and thiopental–ketamine combination was observed to not result in a difference in ECT for patients with treatment-resistant depression. Ketamine at a dose of 1 mg kg-1 given just before ECT did not enhance the antidepressant effect of ECT; however, anxiety scores were increased with ketamine application. © 2015 by Turkish Anaesthesiology and Intensive Care Society