Abstract：
BACKGROUND: Ketamine, electroconvulsive therapy (ECT), and their combination are effective for treating severe depression, but few large-scale studies have compared these.
METHODS: We searched databases for randomized controlled trials (RCTs) using ketamine, ECT, ketamine + ECT, or placebo for severe depression. Standardized measures were efficacy outcomes. Risk of bias was assessed. Stata and ADDIS were used for network meta-analysis (NMA) comparing efficacy and adverse reactions post-treatment. This study was registered on PROSPERO (CRD42023476740).
RESULTS: 17 RCTs with 1370 patients were included. NMA showed ECT and ketamine improved Hamilton Depression Rating Scale (HDRS) versus placebo; other comparisons not significant. Rank probabilities showed highest probability for ECT, followed by ketamine + ECT, ketamine, placebo. No differences in Montgomery-Asberg Depression Rating Scale (MADRS); highest rank probability again for ECT, followed by ketamine + ECT, ketamine, placebo.
CONCLUSIONS: Analysis suggests ECT superior to ketamine and their combination for improving depressive severity, but individualized treatment selection warranted. Higher adverse reactions with ketamine + ECT need further study for optimized combined use.
METHODS: We searched databases for randomized controlled trials (RCTs) using ketamine, ECT, ketamine + ECT, or placebo for severe depression. Standardized measures were efficacy outcomes. Risk of bias was assessed. Stata and ADDIS were used for network meta-analysis (NMA) comparing efficacy and adverse reactions post-treatment. This study was registered on PROSPERO (CRD42023476740).
RESULTS: 17 RCTs with 1370 patients were included. NMA showed ECT and ketamine improved Hamilton Depression Rating Scale (HDRS) versus placebo; other comparisons not significant. Rank probabilities showed highest probability for ECT, followed by ketamine + ECT, ketamine, placebo. No differences in Montgomery-Asberg Depression Rating Scale (MADRS); highest rank probability again for ECT, followed by ketamine + ECT, ketamine, placebo.
CONCLUSIONS: Analysis suggests ECT superior to ketamine and their combination for improving depressive severity, but individualized treatment selection warranted. Higher adverse reactions with ketamine + ECT need further study for optimized combined use.
摘要：
背景：氯胺酮，电惊厥治疗(ECT),它们的组合对治疗重度抑郁症有效，但是很少有大规模的研究比较这些。
方法：我们在数据库中搜索了使用氯胺酮的随机对照试验（RCT），ECT,氯胺酮+ECT,或安慰剂治疗严重抑郁症。标准化措施是疗效结果。评估偏倚风险。使用Stata和ADDIS进行网络荟萃分析（NMA），比较治疗后的疗效和不良反应。本研究在PROSPERO（CRD42023476740）上注册。
结果：纳入17项RCTs，1370例患者。NMA显示，与安慰剂相比，ECT和氯胺酮改善了汉密尔顿抑郁量表（HDRS）；其他比较不显着。等级概率显示ECT的概率最高，其次是氯胺酮+ECT,氯胺酮,安慰剂。蒙哥马利-阿斯伯格抑郁量表（MADRS）没有差异；ECT的最高排名概率，其次是氯胺酮+ECT,氯胺酮,安慰剂。
结论：分析表明，在改善抑郁严重程度方面，ECT优于氯胺酮及其组合，但个性化的治疗选择是有必要的。氯胺酮+ECT的不良反应较高，需要进一步研究以优化联合使用。
方法：我们在数据库中搜索了使用氯胺酮的随机对照试验（RCT），ECT,氯胺酮+ECT,或安慰剂治疗严重抑郁症。标准化措施是疗效结果。评估偏倚风险。使用Stata和ADDIS进行网络荟萃分析（NMA），比较治疗后的疗效和不良反应。本研究在PROSPERO（CRD42023476740）上注册。
结果：纳入17项RCTs，1370例患者。NMA显示，与安慰剂相比，ECT和氯胺酮改善了汉密尔顿抑郁量表（HDRS）；其他比较不显着。等级概率显示ECT的概率最高，其次是氯胺酮+ECT,氯胺酮,安慰剂。蒙哥马利-阿斯伯格抑郁量表（MADRS）没有差异；ECT的最高排名概率，其次是氯胺酮+ECT,氯胺酮,安慰剂。
结论：分析表明，在改善抑郁严重程度方面，ECT优于氯胺酮及其组合，但个性化的治疗选择是有必要的。氯胺酮+ECT的不良反应较高，需要进一步研究以优化联合使用。
