Electroconvulsive therapy (ECT) is an effective treatment for depression, and
esketamine has been shown to have
antidepressant effects. However, it is currently unclear whether adjunctive
esketamine can enhance the clinical efficacy of ECT in real-world clinical practice. In this pragmatic clinical trial, patients with major depression were randomly assigned into two groups: patients received 0.25 mg/kg
esketamine plus
propofol (
esketamine group) or the same volume of saline (control group) plus
propofol. Results indicated that there was no difference in response and remission rates between the two groups. However, patients receiving
esketamine had a higher remission rate of SI and lower psychotic scores. Patients receiving
esketamine also required a lower electric dose, but the seizure duration and cognitive function were comparable between the two groups. Diastolic blood pressure increased after
esketamine injection, but there was no increased risk of
hypertension. Furthermore, incidence of
delirium and
confusion were comparable between the groups. Conclusively, adjunctive
esketamine anesthesia does not provide any advantage in improving the response and remission rates of ECT. However, it can improve remission of SI and alleviate accompanying psychotic symptoms in depressive patients. With adjunctive usage, the adverse cardiovascular and neuropsychiatric events associated with
esketamine appear to be tolerable.