The effect of ketamine, thiopental and ketamine-thiopental combination during electroconvulsive therapy in patients with depressive disorder

The Effect of Ketamine, Thiopental and Ketamine-Thiopental Combination During Electroconvulsive Therapy in Patients with Depressive Disorder Aim: We aimed to evaluate the effect of anaesthesia induction during the electroconvulsive theraphy (ECT) with thiopental (4mg/kg) ketamine (1mg/kg) and ketamine-thiopental (1mg/kg-4mg/kg) combination on the Hamilton Depression Rating Scale (HRSD) and Hamilton Anxiety Rating Scale (HAM-A) and haemodynamic variables in patient with treatment resistant major depression. Materials and Methods: This randomised, controlled study was conducted by Anaesthesia and Reanimation and Psychiatry Departments of Cukurova University Faculty of Medicine. The patients had HDRS scores above 17 were included. The patients were randomly divided into three groups for anesthesia induction options. Group 1 was given thiopental (4 mg/kg), Group 2 was given ketamine (1 mg/kg) and Group 3 was given ketamine (1 mg/kg, thiopental 4 mg/kg). Succinilcholin (1 mg/kg) was applied in all patients for muscle relaxion. HDRS and HAM-A scores were evaluated before ECT tratment, after 3, 6. ECT, and after the final ECT treatment. Systolic and diastolic blood pressures, heart rates, oxygen saturations and seizure durations of the patients were recorded before and after anesthesia induction and after ECT procedure. Results: Fifty-eight patients were included the study. Thirty (52%) of the patients were male and 28 (48%) were female. The mean age was 42,7±15,8 year in the group 1, 44,8±11year in the group 2 and 38,6±6,8 year in the group 3. In all groups, HDRS values were reduced to compared to baseline values. There was no statistical significance difference between the groups about HDRS scores. HAM-A scores were found higher in the ketamine administered groups only. Systolic and diastolic blood pressure values were lower in the group 1 and it was statistically significant. Conclusion: The study showed that, ketamine, thiopental, and ketamin- thiopental combination provided to improve of depression symptoms in patients with treatment-resistant depression during ECT, but there was no difference between the groups. Ketamine, at a dose of 1 mg/kg, given just before ECT, did not enhance the antidepressant effect of ECT, however anxiety scores was increased with ketamin application. Keywords: Depression, anxiety, thiopenthal, ketamine, ECT.