PDF(Pubmed)
Abstract：
Ketamine has been repeatedly demonstrated to be an effective treatment in the management of patients with treatment-resistant depression (TRD). An important question is whether it is equally or more effective than the current gold standard of electroconvulsive therapy (ECT), as the adverse effects of ECT can lead to memory loss and neurocognitive deficits. A literature search was conducted for trials that directly compared the efficacy and adverse effects of ketamine and ECT via PubMed and Google Scholar. A total of 56 articles were identified with six included in this review. The studies included differed significantly in their quality and with differing levels of potential for bias. Ketamine has a more immediate effect when compared to ECT, but the antidepressant effects are shorter-lasting. Cognitive deficits were less pronounced in patients undergoing ketamine therapy. Many studies had a small number of participants and varied widely in the type of ECT used. Allocation bias seems likely in nonrandomized studies. Follow-up times were also short in some studies. The existing literature does not provide sufficient evidence to support the usage of ketamine over that of ECT for TRD, as remission rates were significantly higher over extended periods in ECT groups. Cognitive adverse effects were more pronounced in patients undergoing ECT. More high-quality randomized controlled trials (RCTs) directly comparing these two treatment modalities are required before drawing any firm conclusions.
摘要：
氯胺酮已被反复证明是治疗难治性抑郁症（TRD）患者的有效治疗方法。一个重要的问题是，它是否与当前的电惊厥治疗（ECT）的黄金标准相同或更有效，因为ECT的不良反应会导致记忆丧失和神经认知缺陷。通过PubMed和GoogleScholar对直接比较氯胺酮和ECT的疗效和不良反应的试验进行了文献检索。共确定了56篇文章，其中6篇纳入了这篇综述。这些研究包括在质量上存在显着差异，并且具有不同程度的偏见潜力。与ECT相比，氯胺酮具有更直接的作用，但是抗抑郁作用持续时间短。接受氯胺酮治疗的患者的认知障碍不太明显。许多研究的参与者人数很少，并且所使用的ECT类型差异很大。在非随机研究中，分配偏差似乎很可能。在一些研究中，随访时间也很短。现有的文献没有提供足够的证据来支持使用氯胺酮超过ECT用于TRD，由于ECT组的缓解率在延长的时间段内显著较高。在接受ECT的患者中，认知不良反应更为明显。在得出任何确定的结论之前，需要更多高质量的随机对照试验（RCT）直接比较这两种治疗方式。
