Two groups of psychiatrists in the United Kingdom have been carrying out studies on the use of ketamine during ECT, one group in Scotland and the other in England. I have featured the studies here, here, here, here and here.
The teams were investigating whether the use of ketamine as anaesthetic (Scotland) or added to anaesthetic (England) might make ECT work quicker and/or cause less cognitive damage. Both teams got the same results: no significant difference. The English team concluded: “The main finding of the Ketamine-ECT study is that there was no evidence of benefit in terms of cognitive and efficacy outcomes from using low-dose ketamine as an adjunctive anaesthetic agent for ECT, as currently administered in the UK.” And the Scottish team reached a similar conclusion.
The Scottish team recruited 40 ECT patients for their experiment. They were on average younger and more male than ECT patients in general in Scotland. All had bilateral ECT, as is the custom in Scotland. The team had a problem with “patient attrition”: only 26 patients were still there at the last follow-up one month after ECT. Reasons for withdrawal included having another course of ECT, having maintenance ECT, having fewer than four treatments, having a complication, taking a unprescribed drug or just deciding not to continue in the trial.
The English team, who were funded to the tune of over a million pounds, had a particular problem with recruitment. According to their original press release they were looking to recruit 160 ECT patients over a large area of the north of England. But, out of a total of 628 patients who were given ECT, they ended up with just 70 starting the trial and 37 still there for the final assessment four months after ECT. And to get even that 70 they had to change their protocol so that patients were only excluded if they had had previous ECT in the past three, rather than six, months.
“In total, 628 patients received ECT at 11 ECT suites based in seven NHS trusts in the north of England, of whom 31% were potentially eligible for the study (47% were ineligible because of detention under the MHA).”
A few detained patients consent to ECT. However most of those 47 per cent would have been treated without their consent, having been deemed incapable of making a decision. In England, ECT without consent is becoming nearly as common as ECT with consent.
“The remission rate at the end of treatment was 35% on saline and 39% on ketamine…” There were seven “serious adverse events”: two suicide attempts, two overdoses requiring hospital treatment, one case of “clinical deterioration” requiring admission to hospital, one case of chest pain requiring admission to hospital, and one case of a spontaneous seizure and status epilepticus between treatments. The authors show some reluctance to implicate ECT in any of these events. The suicide attempts “were deemed likely to be related to the underlying clinical illness, although a triggering effect of ECT cannot be excluded” and the spontaneous seizure “may be a rare adverse effect of ECT,157 but concomitant treatment of the patient with quetiapine is also likely to be a cause.”
Nearly 90 per cent ECT patients had bilateral treatment. The mean amount of electrical charge was 306 mC for the ketamine group and 276.5 mC for the control group.