Lamotrigine was ineffective in either limiting side effects or augmenting ketamine efficacy and the two treatment groups did not differ in MADRS scores at any point (p = 0.36). In the second stage no difference between the groups (log-rank χ2 = 0.17, degrees of freedom = 1, p = 0.68) in time to relapse, which for riluzole was a mean of 24.4 days (95% CI 15.9–33.0) and for placebo was 22.0 days (95% CI 14.9–29.1). Ketamine as an antidepressant in ECT or surgery There are clear parallels between ketamine and ECT insofar as both have rapid actions and their effects are typically short-lived.

In addition ketamine has been Inhibitors,research,lifescience,medical used as an anaesthetic, including induction prior to ECT, for decades, although its propensity to raise blood pressure through systemic catecholamine release and to cause aversive dissociative Inhibitors,research,lifescience,medical experiences generally makes it a second-line drug. It is thus not surprising that some studies have explored their combined use, especially as ketamine may also, by attenuating Glu release, moderate neurotoxic and cognitive impairment from ECT-induced cortical hyperexcitability [MacPherson and Loo, 2008]. Furthermore, unlike most anaesthetics ketamine Inhibitors,research,lifescience,medical is proconvulsive,

which might facilitate ECT. Studies have evaluated augmenting ECT with a subanaesthetic dose of ketamine, using ketamine as the anaesthetic agent and one study looked at the use of ketamine as an anaesthetic agent in general orthopaedic surgery in depressed Inhibitors,research,lifescience,medical patients. The results shows promising potential for ketamine, with most work showing additional, see more albeit brief,

benefits from its use, although not all research showed positive outcomes. The characteristics of these studies are detailed in Table 1 and results are given in Table 4. Table 4. Results of included studies addressing the use of ketamine as an antidepressant in ECT or surgery. ECT augmented with subanaesthetic Inhibitors,research,lifescience,medical ketamine Two recent studies have evaluated augmentation of ECT with ketamine, one showing initial, although not sustained, positive results [Loo et al. 2012], the other [Abdallah et al. 2012] reporting no benefit. Loo and colleagues undertook a RCT of 51 participants with TRD (-)-p-Bromotetramisole Oxalate undergoing a course of ultrabrief pulse-width right unilateral ECT randomized to augmentation with either a subanaesthetic dose of ketamine (0.5 mg/kg) or saline placebo in addition to standard thiopentone anaesthetic [Loo et al. 2012]. ECT was given three times a week, with ketamine or placebo given after induction of anaesthesia in all sessions. No group differences in neuropsychometric testing, measured on a battery of tests, were observed at any time point, although the study was only powered to detect large changes, and ketamine had no effect on seizure duration.