A Bayesian framework systematic review and meta-analysis of anesthetic agents effectiveness/tolerability profile in electroconvulsive therapy for major depression
Sci Rep. 2016-01-25; 6(1):
DOI: 10.1038/srep19847
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1. Sci Rep. 2016 Jan 25;6:19847. doi: 10.1038/srep19847.
A Bayesian framework systematic review and meta-analysis of anesthetic agents
effectiveness/tolerability profile in electroconvulsive therapy for major
depression.
Fond G(1)(2), Bennabi D(3)(2), Haffen E(3)(2), Brunel L(1), Micoulaud-Franchi
JA(4), Loundou A(5), Lançon C(4)(5)(2), Llorca PM(2)(6), Auquier P(5)(7), Boyer
L(5)(7).
Author information:
(1)Université Paris Est-Créteil, Pôle de psychiatrie des hôpitaux universitaires
H Mondor DHU Pe-PSY, INSERM U955, Eq Psychiatrie translationelle, Fondation
FondaMental Fondation de coopération scientifique en santé mentale, Créteil,
France.
(2)Network of Expert centres, FondaMental Foundation, Créteil 94000, France.
(3)Department of Clinical Psychiatry, CIC-1431, University Hospital of Besançon,
EA Neurosciences 481, University of Franche-Comté, Besançon, France.
(4)Service d’explorations fonctionnelles du système nerveux, Clinique du sommeil,
CHU de Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France.
(5)Aix-Marseille University, EA 3279 Research Unit – Public Health: Chronic
diseases and quality of life, Marseille, France.
(6)University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
(7)Department of Epidemiology, Timone University Hospital, APHM, Marseille,
France.
The aim of this study was to assess the efficacy and tolerability/acceptability
of 6 anesthetic agents in ECT for depressive disorders. We systematically
reviewed 14 double-blind randomized controlled trials (610 participants).
Efficacy was measured by the mean scores on validated depression scales at 6 ECT
(or the nearest score if not available), number of responders at the end of
treatment and seizure duration. The acceptability was measured by the proportion
of patients who dropped out of the allocated treatment, and the tolerability by
the number of serious adverse events and post-treatment cognition assessment.
After excluding the trials responsible for heterogeneity, depression scores of
patients who were administered methohexital were found to be significantly more
improved than those who received propofol (p = 0.001). On the contrary, those who
were administered propofol had lower depression scores than those with thiopental
at the end of treatment (p = 0.002). Compared to propofol, methohexital was found
to be significantly associated with higher seizure duration (p = 0.018). No
difference was found for the acceptability profile (all p > 0.05). In summary,
ketamine and methohexital may be preferred to propofol or thiopental in regard of
effectiveness in depression scores and increased seizure duration. Further
studies are warranted to compare ketamine and methohexital.
DOI: 10.1038/srep19847
PMCID: PMC4726191
PMID: 26806849 [Indexed for MEDLINE]