Efficacy And Safety Of Esketamine In MECT Treatment Of Refractory Bipolar Depression

BackgroundBipolar depression occupies most of the period of bipolar disorder(BD),with a high incidence rate,high disability rate and high mortality.About a quarter of patients with bipolar disorder belong to treatment-resistant bipolar depression(TRBD),which faces problems such as slow onset of antidepressants,low efficacy,and rapid circulation in treatment.Modified electroconvulsive therapy(MECT)has been widely used in clinical practice and is the fastest and most effective treatment among all antidepressant treatments.It has good therapeutic effects on patients with unipolar and bipolar depression.Esketamine non-competitive N-methyl-D-aspartic acid(NMDA)receptor antagonist is the S-isomer of ketamine.As a new type of antidepressant,it has the effect of quickly and effectively relieving depressive symptoms,alleviating suicidal ideation,and improving pleasure loss.In addition,compared to propofol,the effect of eskeamine on the respiratory and circulatory systems is relatively small;Compared with ketamine,Esketamine has better safety and tolerance.In recent years,there have been studies on the treatment of depression with intravenous and nasal ketamine,with good therapeutic effects and fewer adverse reactions.Esketamine has dual analgesic and sedative effects,and its use as a MECT anesthetic for the treatment of refractory bipolar depression has not been reported in China.The aim of this study is to evaluate the efficacy and safety of Esketamine in the treatment of refractory bipolar depression using MECT.In addition,the correlation between clinical characteristics,symptoms,and cognitive function of TRBD patients was also explored.Objective1.Evaluate the efficacy and safety of Esketamine as a MECT anesthetic in the treatment of refractory bipolar depression.2.Explore the correlation between clinical features,symptoms,and cognitive function in patients with refractory bipolar depression.2.MethodsFifteen patients with TRBD were collected,and Esketamine was used as a MECT anesthetic for a total of 8 treatments.At baseline and after each treatment,use the Asberg Side effect Rating Scale for Antidepressant(SERS),Hamilton Depression Scale 17(HAMD-17),Montgomery Asberg Depression Rating Scale(MADRS)to assess depressive symptoms,Hamilton Anxiety Scale(HAMA)to assess anxiety symptoms,The Brief Psychiatric Rating Scale(BPRS)assesses psychiatric symptoms,the Young Mania Rating Scale(YMRS)assesses the risk of manic transition,the Beck Scale for Suicide Idea(BSI)assesses suicidal ideation,and the MATRICS Consensus Cognitive Battery(MCCB)assesses cognitive function at baseline and after the last treatment.ResultsThis study included 15 patients with TRBD who received MECT treatment,with an effective rate of 60% and a remission rate of 20%,respectively.After MECT treatment,TRBD patients showed varying degrees of decrease in HAMD-17,HAMA,MADRS,pleasure loss,BPRS,and BSI scores compared to baseline.Among them,there were statistical differences in HAMD-17(P=0.002)and HAMA(P=0.028)scores after the first treatment,while MADRS(P<0.001),pleasure loss(P<0.001),BPRS(P=0.007),and BSI(P=0.040)scores after the second treatment.There was no significant difference in cognitive function changes between TRBD patients before and after treatment.The common adverse reactions in the MECT treatment of ketamine as an anesthetic in this study are headache,nausea,vomiting,and elevated blood pressure.Correlation analysis shows that the vocabulary learning ability of TRBD patients is negatively correlated with their age of onset,and no correlation was found between the effective rate and remission rate of TRBD patients after treatment and their clinical characteristics and symptoms.Conclusion1.Esketamine as an anesthetic for MECT treatment can quickly and effectively improve depression,anxiety,and psychiatric symptoms in TRBD patients,alleviate suicidal ideation,and improve pleasure loss.The common adverse reactions observed in MECT treatment with ketamine as an anesthetic are headache,nausea,vomiting,and elevated blood pressure,which are mild in severity,short in duration,and relatively safe.2.The younger the initial age of TRBD patients,the poorer their vocabulary learning ability may be.In patients with TRBD with family history,the age of onset and the age of diagnosis may be earlier than those without family history.