921, p = 0.343; η2 = 0.22). No psychotomimetic problems were noted in the either ketamine group, although these typically brief and self-limiting phenomena might be masked by post-anaesthetic recovery. The work by Abdallah and colleagues had a similar design, although it included participants with bipolar depression, and ECT could be unilateral or bilateral for six sessions over 2 weeks [Abdallah et al. 2012]. The number of participants evaluated (n = 18) was smaller than originally planned as the trial was prematurely terminated

due to a lack of between-group clinical differences (measured on the HDRS) in improvement Inhibitors,research,lifescience,medical of depressive selleck catalog symptoms at 24 or 72 hours after the first ECT session, or after the final (sixth) one. This result is interesting in that the very commonly seen initial positive response

to ketamine was not demonstrated. The authors postulate Inhibitors,research,lifescience,medical that the known GABAergic potentiation and AMPA blocking effects of the barbiturate anaesthetic might have pharmacologically countered the actions of ketamine. Use of ketamine as an anaesthetic in ECT Three papers explored the effect of ketamine use as the anaesthetic agent in ECT compared with a common anaesthesia. The methodology was quite different in each, with two prospective studies, one evaluating single-session ECT [Wang et al. 2012] and the other an Inhibitors,research,lifescience,medical eight-session protocol [Okamoto et al. 2010], as well as one retrospective case-note study [Kranaster et al. 2011]. All demonstrated significantly improved depression scores in the ketamine groups, although benefits were short-lived. The single session ECT study by Wang and colleagues had an interesting methodology

in that 48 patients Inhibitors,research,lifescience,medical with MDD were randomized into three equal-sized (n = 16) groups, each receiving a differing ECT anaesthesia protocol [Wang et al. 2012]: ‘standard’ propofol, ketamine (0.8 mg/kg) and a third group that received combined ketamine (0.8 mg/kg) and propofol anaesthesia. This allowed the authors to test dual hypotheses of the clinical superiority Inhibitors,research,lifescience,medical of ketamine in treating depressive symptoms as well evaluating whether the combination GSK-3 might result in propofol ameliorating any ketamine-induced cardiovascular excitement. Patients were clinically assessed 1 day before and 1, 2, 3 and 7 days post-single-session bilateral ECT with the HDRS in a double-blinded paradigm. HDRS scores improved earlier (up to and including day 3 post-ECT) in the two ketamine groups compared with the propofol-alone group (p < 0.01), but this difference was lost by day 7 (p > 0.05). The combination anaesthesia group showed fewer physical (hypertension, p = 0.037) and psychological (post-anaesthetic hallucinations, p = 0.33) adverse effects than the ketamine-alone group. The longer prospective study [Okamoto et al.