A Bayesian framework systematic review and meta-analysis of anesthetic agents effectiveness/tolerability profile in electroconvulsive therapy for major depression

Guillaume Fond, Djamila Bennabi, Emmanuel Haffen, Lore Brunel, Jean-Arthur Micoulaud-Franchi, Anderson Loundou, Christophe Lançon, Pierre-Michel Llorca, Pascal Auquier, Laurent Boyer, Guillaume Fond, Djamila Bennabi, Emmanuel Haffen, Lore Brunel, Jean-Arthur Micoulaud-Franchi, Anderson Loundou, Christophe Lançon, Pierre-Michel Llorca, Pascal Auquier, Laurent Boyer

Abstract

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.

Figures

Figure 1. Prisma flow chart.
Figure 1. Prisma flow chart.
Figure 2. Comparative effectiveness of the 6…
Figure 2. Comparative effectiveness of the 6 anesthetic agents (proxy by depression score improvement at 6 ECT or the nearest score if not available).
(A) Ketamine vs Thiopental. (B) Ketamine vs Propofol. (C) Propofol vs Methohexital. (D) Propofol vs Thiopental.
Figure 3. Comparative efficacy of anesthetic agents…
Figure 3. Comparative efficacy of anesthetic agents for ECT induction in major depression, proxy by response rates at the end of treatment.
(A) Ketamine vs Thiopental. (B) Propofol vs Methohexital. (C) Propofol vs Thiopental.
Figure 4. Comparative mean seizure duration associated…
Figure 4. Comparative mean seizure duration associated with the administration of each anesthetic agent.
(A) Ketamine vs Thiopental. (B) Ketamine vs Propofol. (C) Propofol vs Methohexital. (D) Propofol vs Thiopental.
Figure 5. Comparative acceptability of the anesthetic…
Figure 5. Comparative acceptability of the anesthetic agents, proxy by dropout rates.
(A) Ketamine vs Thiopental. (B) Ketamine vs Propofol. (C) Propofol vs Methohexital. (D) Propofol vs Thiopental.
Figure 6. Network of induction agent comparisons…
Figure 6. Network of induction agent comparisons in electroconvulsive therapy: Depression scores.
Circle size reflects number of participants and the line width of the lines reflects the number of direct comparisons. No connecting line between 2 treatments indicates that there was no direct comparison.
Figure 7. Network of induction agent comparisons…
Figure 7. Network of induction agent comparisons in electroconvulsive therapy: Response rates.
Circle size reflects number of participants and the line width of the lines reflects the number of direct comparisons. No connecting line between 2 treatments indicates that there was no direct comparison.
Figure 8. Network of induction agent comparisons…
Figure 8. Network of induction agent comparisons in electroconvulsive therapy: Seizure durations.
Circle size reflects number of participants and the line width of the lines reflects the number of direct comparisons. No connecting line between 2 treatments indicates that there was no direct comparison.
Figure 9. Network of induction agent comparisons…
Figure 9. Network of induction agent comparisons in electroconvulsive therapy: dropout rates.
Circle size reflects number of participants and the line width of the lines reflects the number of direct comparisons. No connecting line between 2 treatments indicates that there was no direct comparison.

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Source: PubMed

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