Comparative efficacy and tolerability of different anesthetics in electroconvulsive therapy for major depressive disorder: A systematic review and network meta-analysis

作者全名："Ren, Li; Yu, Jian; Zeng, Jie; Wei, Ke; Li, Ping; Luo, Jie; Shen, Yiwei; Lv, Feng; Min, Su"

作者地址："[Ren, Li; Wei, Ke; Li, Ping; Luo, Jie; Shen, Yiwei; Lv, Feng; Min, Su] Chongqing Med Univ, Affiliated Hosp 1, Dept Anesthesiol, Chongqing, Peoples R China; [Yu, Jian] Tongji Univ, Shanghai Peoples Hosp 10, Anesthesia & Brain Res Inst, Dept Psychiat, Shanghai, Peoples R China; [Zeng, Jie] Chongqing Med Univ, Dept Anesthesiol, Stomatol Hosp, Chongqing, Peoples R China"

通信作者："Lv, F; Min, S (通讯作者)，Chongqing Med Univ, Affiliated Hosp 1, Dept Anesthesiol, Chongqing, Peoples R China."

来源：JOURNAL OF PSYCHIATRIC RESEARCH

ESI学科分类：PSYCHIATRY/PSYCHOLOGY

WOS号：WOS:001170828900001

JCR分区：Q1

影响因子：3.7

年份：2024

卷号：171

期号：　

开始页：116

结束页：125

文献类型：Review

关键词：Electroconvulsive therapy; Depression; Anesthesia; Network meta -analysis

摘要："Electroconvulsive therapy (ECT) is one of the most effective treatments for major depressive disorder. Modern ECT is conducted with anesthesia, however, the optimal anesthetic agent for ECT is yet to be understood. This study is aimed to compare the effects of different anesthetic agents on antidepressant efficacy and tolerability in depressed individuals undergoing ECT. We searched MEDLINE, EMBASE, the CENTRAL and PsycINFO for randomized controlled trials from database inception until Nov 13, 2022 (PROSPERO: CRD42022375407). Global and local inconsistencies, heterogeneity and publication bias were assessed. Rankings were calculated with the surface under the cumulative ranking curve. A total of 33 studies involving 1898 patients were enrolled. Remission rates were higher for ketamine anesthesia as compared to adjunctive ketamine and propofol. In terms of ranking, ketamine was found to be first in terms of response/remission rates and depressive scores after the 1st, 3rd and 6th ECT and at the end of ECT session, while a higher incidence of adverse events was also observed. No significant advantage of any anesthetic was revealed for the cognitive function after ECT. In summary, based on current evidence, no specific anesthetic is recommended for ECT anesthesia. However, despite more side effects, ketamine monoanesthesia seems to reveal a potential benefit in improving antidepressant efficacy of ECT, and further studies are needed to investigate the relationship between anesthetic agents and the therapeutic effect of ECT."

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