Efficacy and safety of a 4-week course of repeated subcutaneous ketamine injections for treatment-resistant depression (KADS study): randomised double-blind active-controlled trial.

BACKGROUND: Prior trials suggest that intravenous racemic ketamine is a highly effective for treatment-resistant depression (TRD), but phase 3 trials of racemic ketamine are needed. AIMS: To assess the acute efficacy and safety of a 4-week course of subcutaneous racemic ketamine in participants with TRD. Trial registration: ACTRN12616001096448 at www.anzctr.org.au. METHOD: This phase 3, double-blind, randomised, active-controlled multicentre trial was conducted at seven mood disorders centres in Australia and New Zealand. Participants received twice-weekly subcutaneous racemic ketamine or midazolam for 4 weeks. Initially, the trial tested fixed-dose ketamine 0.5 mg/kg versus midazolam 0.025 mg/kg (cohort 1). Dosing was revised, after a Data Safety Monitoring Board recommendation, to flexible-dose ketamine 0.5-0.9 mg/kg or midazolam 0.025-0.045 mg/kg, with response-guided dosing increments (cohort 2). The primary outcome was remission (Montgomery-Åsberg Rating Scale for Depression score ≤10) at the end of week 4. RESULTS: The final analysis (those who received at least one treatment) comprised 68 in cohort 1 (fixed-dose), 106 in cohort 2 (flexible-dose). Ketamine was more efficacious than midazolam in cohort 2 (remission rate 19.6% v. 2.0%; OR = 12.1, 95% CI 2.1-69.2, P = 0.005), but not different in cohort 1 (remission rate 6.3% v. 8.8%; OR = 1.3, 95% CI 0.2-8.2, P = 0.76). Ketamine was well tolerated. Acute adverse effects (psychotomimetic, blood pressure increases) resolved within 2 h. CONCLUSIONS: Adequately dosed subcutaneous racemic ketamine was efficacious and safe in treating TRD over a 4-week treatment period. The subcutaneous route is practical and feasible.

Propofol y pentotal como agentes anestésicos en la terapia electroconvulsiva: un estudio retrospectivo en el trastorno depresivo mayor / Propofol and thiopental as anesthetic agents in electroconvulsive therapy: a retrospective study in major depression

Objetivo. Determinar la influencia de la utilización de propofol y pentotal como anestésicos en la terapia electroconvulsiva (TEC), en relación con la duración de la crisis, la dosis eléctrica, la eficacia clínica, el perfil cardiovascular y la aparición de efectos cognitivos. Método. Estudio retrospectivo sobre 127 pacientes que recibieron TEC bilateral como tratamiento de un episodio depresivo mayor. Resultados. La duración media de la convulsión eléctrica en el grupo de propofol fue significativamente más corta que en el de pentotal (21,23 ± 6,09 versus 28,24 ± 6,67 s; p < 0,001). La dosis de estímulo media fue de 348,22 mC en el grupo de propofol y de 238 mC en el grupo de pentotal (p < 0,001). Propofol se asoció a un menor incremento de la tensión arterial. No se encontraron diferencias en la respuesta clínica al tratamiento ni en la aparición de otros efectos adversos. Conclusiones. El anestésico utilizado en la TEC puede determinar diferencias en parámetros como la duración de la crisis o la carga eléctrica aplicada. Sin embargo, estas diferencias no parecen traducirse en la eficacia clínica ni en el patrón de efectos adversos (AU)

Objective. To determine the influence of propofol and thiopental as anesthetics in electroconvulsive therapy (ECT), as regards, seizure duration, electrical charge, clinical efficacy, cardiovascular profile, and presence of adverse cognitive effects. Methods. A retrospective design including 127 patients who received bilateral ECT for the treatment of a major depressive episode. Results. The mean seizure duration in the propofol group was significantly shorter than in the thiopental group (21.23 ± 6.09 versus 28.24 ± 6.67 seconds, P < .001). The mean stimulus charge was 348.22 mC in the propofol group, and 238 mC in the thiopental group (P < .001). Propofol was associated with a lower increase in blood pressure. There were no differences between groups in treatment response or presence of adverse effects. Conclusions. The anesthetic agent used in ECT might determine differences in parameters such as seizure duration or electrical charge. However, this does not seem to be translated into differences in clinical efficacy or the pattern of adverse effects observed (AU)

Propofol and thiopental as anesthetic agents in electroconvulsive therapy: a retrospective study in major depression.

OBJECTIVE: To determine the influence of propofol and thiopental as anesthetics in electroconvulsive therapy (ECT), as regards, seizure duration, electrical charge, clinical efficacy, cardiovascular profile, and presence of adverse cognitive effects. METHODS: A retrospective design including 127 patients who received bilateral ECT for the treatment of a major depressive episode. RESULTS: The mean seizure duration in the propofol group was significantly shorter than in the thiopental group (21.23±6.09 versus 28.24±6.6 7s, P<.001). The mean stimulus charge was 348.22 mC in the propofol group, and 238 mC in the thiopental group (P<.001). Propofol was associated with a lower increase in blood pressure. There were no differences between groups in treatment response or presence of adverse effects. CONCLUSIONS: The anesthetic agent used in ECT might determine differences in parameters such as seizure duration or electrical charge. However, this does not seem to be translated into differences in clinical efficacy or the pattern of adverse effects observed.

Tratamiento de la depresión con bupropión en monoterapia / No disponible

No disponible

Papel de bupropión en el tratamiento de la depresión resistente. Manejo de bupropión en combinación / No disponible

No disponible

Uso de bubropión en pacientes ancianos / No disponible

No disponible

Bupropión y patología dual / No disponible

No disponible

Tolerancia y perfil de efectos secundarios de bupropión / No disponible

No disponible

Bupropión y depresión bipolar / No disponible

No disponible