Effect Of Propofol Combined With Ketamine Anesthesia On Therapeutic Response Of Depression Disorder Patiens Receiving Modern Electroconvulsive Therapy

Objective:Mordern electroconvulsive therapy(MECT) is preferred treatment method of depression disorder. Now, depression disorder patients undergo MECT mostly under propofol anesthesia. Recent research showed that ketamine exerts quick, obvious and persistent antidepressant-like effect, but ketamine can induce various degrees of side effects such as cardiovascular system excitement, post-anesthesia nausea and vomit and hallucinogenic activity, so it is often combined with propofol in clinical anesthesia, because propofol can remarkably inhibit or eliminate ketamine's side effects. The present study aimed to investigate the effect of ketamine combined propofol anesthesia on the MECT-induced antidepressant-like action in depression disorder. Methods:Hamilton depression rating score(HDRS)>20 scores, first Modern Electroconvulsive therapy (MECT) depression disorder patients were randomly divided into 3 groups:propofol group(group P, n=12); ketamine group (group K, n=12); propofol plus ketamine group(group PK, n=16). Propofol(1.5mg/kg), Ketamine(0.8mg/kg) and Propofol(1.5mg/kg)+Ketamine(0.8mg/kg) were respectively infused to each group patients before MECT. All patients's HDRS were judged in 1 day before MECT and 1,2,37 day after MECT, Seizure energy index(SEI), Seizure duration(SD) and side effects were observed during MECT; All patients were given general antidepressants therapy after MECT. Clinical response was defined as a 50% or greater decrease in the HDRS score from baseline and clinical remission was defined as a HDRS score of 7 or lower. Results:HDRS before MECT have no difference between the three groups (p>0.05), but HDRS decreased obviously 1,2,3,7day after MECT(p<0.05); Subjects receiving ketamine or propofol+ketamine showed significant improvement in therapeutic response compared with subjects receiving propofol within 1,2,37day after MECT(p<0.05); Subjects receiving propofol+ketamine showed no significant difference in therapeutic response compared with subjects receiving ketamine within 1,2,37 day after MECT(p<0.05). There were no clinical response patients within 3 day after MECT and the percent rate of clinical response patients was 58% at 7 day after MECT in P group, no clinical remission patients in P group at 7 day after MECT; However the percent rate of clinical response patients was 92% at 1 day and 100% at 2,3, 7day after MECT in K group, the percent rate of clinical remission patients was 58% at 7 day after MECT; In PK group, the percent rate of clinical response patients was 75% at 1 day and 100% at 2,3,7day after MECT,the percent rate of clinical remission patients was 50% at 7 day after MECT. The percent rate of clinical response and remission patients at each point time in K or PK group was obviously higher than that in P group(p<0.05); SEI and SD in K or PK group were higher or longer than that in P group during MECT; The side effects in subjects receiving propofol+ketamine were lower obviously than that in subjects receiving ketamine. Conclusion: Propofol combined with ketamine anesthesia can quickly and obviously improve the therapeutic response of depression patients receiving MECT treatment and alliviate the side effects of ketamine anesthesia during MECT. One of the mechanism may be that ketamine itself has antidepressant action and induce higher SEI and longer SD during MECT.