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Comparing Effects of Ketamine and Thiopental Administration During Electroconvulsive Therapy in Patients With Major Depressive Disorder: A Randomized, Double-Blind Study

Yoosefi, Abolghasem MD*; Sepehri, Amir Sasan PharmD; Kargar, Mona PharmD; Akhondzadeh, Shahin PhD§; Sadeghi, Majid MD; Rafei, Ali MSc; Alimadadi, Abbas MS#; Ghaeli, Padideh PharmD**

doi: 10.1097/YCT.0b013e3182a4b4c6
Original Studies

Objectives Recently, ketamine has attracted attention for induction of anesthesia during electroconvulsive therapy (ECT). This study compared the effects of thiopental and ketamine in patients undergoing this procedure.

Method This randomized, double-blind clinical trial included inpatients, with major depressive disorder, undergoing ECT. Subjects were randomly allocated to receive either ketamine or thiopental. Mini-Mental State Examination and Hamilton Depression Rating Scale were used to assess memory and depression, respectively, before the first and second ECT sessions as well as a few days and 1 month after the sixth session. The electrical charge, seizure duration, blood pressure, and heart rate were also recorded.

Results Of the 31 patients, 17 met the criteria for the ketamine group but 2 dropped out of the study. Therefore, 15 patients received ketamine and 14 received thiopental. Each patient underwent 6 ECT sessions. At the end of the study, depression improved significantly in both groups. However, a significant difference in depression improvement was noted only before the second ECT with ketamine compared with thiopental. Despite a significant decline in Mini-Mental State Examination scores in both groups after the first ECT, cognitive function improved afterward but was only significant in ketamine group. Seizure duration was found to be significantly longer with ketamine. Stimulus intensity used for each ECT increased gradually and linearly with a greater increase observed in thiopental group.

Conclusions Ketamine administration during ECT is well tolerated and patients may experience earlier improvement in depressive symptoms, longer seizure duration, and better cognitive performance when compared with thiopental.

From the *Department of Anesthesiology, Amir Alam Hospital, †Department of Clinical Pharmacy, Faculty of Pharmacy, ‡Research Center for Rational Use of Drugs, Department of Clinical Pharmacy, §Psychiatric and Psychology Research Centre, Roozbeh Hospital, ∥Department of Psychiatry, Roozbeh Hospital, and ¶Department of Statistics and Mathematics, Tehran University of Medical Sciences; #Department of Psychology, University of Applied Science and Technology; **Faculty of Pharmacy and Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Received for publication April 12, 2013; accepted July 8, 2013.

Reprints: Padideh Ghaeli, PharmD, Faculty of Pharmacy and Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran 13337-95914 (e-mail:

This research was a part of Dr Sepehri’s postdoctoral residency in clinical pharmacy and was supported by the Faculty of Medicine, Tehran University of Medical Sciences (grant number 88-02-30-8979).

The authors have no conflicts of interest or financial disclosures to report.

This clinical trial is registered at and its identifier is as follows: IRCT201201247202N3.

© 2014 by Lippincott Williams & Wilkins