<p>BDNF and the Antidepressant Effects of Ketamine and Propofol in Electroconvulsive Therapy: A Preliminary Study</p>

Abstract

Objective: Ketamine and propofol have become increasingly popular in electroconvulsive therapy (ECT) anaesthesia. This study was conducted to examine whether changes in serum levels of brain-derived neurotrophic factor (BDNF) are associated with the antidepressant effects of ketofol, a combination of ketamine and propofol, in ECT for patients with treatment-resistant depression (TRD). Methods: Thirty patients with TRD (18-65 years) were enrolled and underwent eight ECT sessions with ketamine (0.5 mg/kg) plus propofol (0.5 mg/kg) (ketofol). Symptom severity was monitored using the 17-item Hamilton Depression Rating Scale (HAMD-17) and the Brief Psychiatric Rating Scale (BPRS), and serum levels of BDNF were examined by enzyme-linked immunosorbent assay (ELISA) at baseline and after 2, 4, and 8 ECT treatments. Serum levels of BDNF were also collected from thirty healthy controls. Results: At baseline, there were no significant differences in serum levels of BDNF between patients with TRD and healthy controls. The response and remission rates in patients with TRD were 100% (30/30) and 53.3% (16/30) after ECT treatment, respectively. Despite a significant reduction in HAMD-17 and BPRS scores after ECT, no changes in serum levels of BDNF were observed after ECT treatment when compared to baseline. No association was found between serum levels of BDNF and changes in illness severity. Conclusion: Serum levels of BDNF did not represent a suitable candidate biomarker for determining the antidepressant effects of ketofol during ECT for patients with TRD.

Serum BDNF levels and the antidepressant effects of electroconvulsive therapy with ketamine anaesthesia: a preliminary study

“…In line with findings from early studies ( Fernandes et al, 2009 ; Huang et al, 2020 ; Maffioletti et al, 2019 ; Polyakova et al, 2015a ; Ryan, Dunne & McLoughlin, 2018 ), no significant difference was observed in serum BDNF levels between patients with TRD and healthy controls. However, other studies have reported that patients with depression exhibit reduced serum BDNF levels compared to healthy controls ( Allen et al, 2015 ; Karege et al, 2002 ; Kishi et al, 2017 ; Matrisciano et al, 2009 ; Nase et al, 2016 ; Rapinesi et al, 2015 ; Wolkowitz et al, 2011 ; Zheng et al, 2020 ), suggesting that serum BDNF deficit might represent a potential biomarker in patients with depression.…”

“…All patients were recruited from the wards of the Affiliated Brain Hospital of Guangzhou Medical University based on the following criteria: (1) age from 18 to 65 years; (2) diagnosed with major depression according to the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) with a current major depressive episode; (3) having severe depressive symptoms (HAMD-17 scores ≥ 20) at screening; (4) did not respond adequately to appropriate courses of at least two antidepressants in the current episode ( Huang et al, 2020 ; Zheng et al, 2020 ); (5) had no history of severe physical illness (i.e., Parkinson disease) and no drug or alcohol abuse; (6) had no history of seizures; (7) was not breastfeeding or pregnant; and (8) had no any contraindication for ketamine anaesthesia and ECT. All patients with TRD provided written informed consent at the beginning of participation.…”

“…For example, Petrides et al (2001) reported that the remission rate was 87% for both psychotic and nonpsychotic patients with MDD after an acute ECT course. To minimize the clinical risks and subjective unpleasantness during ECT, patients are administered an intravenous anaesthetic, such as thiopental, methohexital, propofol, ketamine or even a combination of ketamine and propofol (ketofol) ( Huang et al, 2020 ; Zheng et al, 2019a ). A recent meta-analysis of 16 trials ( n = 928) found that ketamine used in ECT accelerated the improvement of depressive symptoms in patients with MDD, with a short-term advantage in antidepressive effect at the early stages of ECT ( Ren et al, 2018 ).…”

“…For instance, a recent study reported that ECT treatment with ketamine anaesthesia, but not with methohexital anaesthesia, significantly increased plasma BDNF levels ( Carspecken et al, 2018 ). However, another study found that ECT with ketofol anaesthesia was not correlated with enhanced serum BDNF levels ( Huang et al, 2020 ). Moreover, baseline serum BDNF levels did not appear to be an eligible biomarker for predicting the antidepressant response to ECT with ketofol anaesthesia, as measured using the 17-item Hamilton Depression Rating Scale (HAMD-17) ( Huang et al, 2020 ).…”

“…However, another study found that ECT with ketofol anaesthesia was not correlated with enhanced serum BDNF levels ( Huang et al, 2020 ). Moreover, baseline serum BDNF levels did not appear to be an eligible biomarker for predicting the antidepressant response to ECT with ketofol anaesthesia, as measured using the 17-item Hamilton Depression Rating Scale (HAMD-17) ( Huang et al, 2020 ).…”