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Electroconvulsive Therapy

Electroconvulsive Therapy Potentially a Better Option in Treating Major Depressive Episodes Than Ketamine

Jessica Ganga
01/05/2023

Electroconvulsive therapy (ECT) may be a better option for individuals experiencing a major depressive episode compared with ketamine treatment, according to a recent systematic review.

The researchers reviewed six clinical trials and analyzed their data to determine whether ketamine was as effective as ECT among patients with a major depressive episode. PubMed, MEDLINE, Cochrane Library, and Embase databases were used to pinpoint studies relevant to the researchers’ inclusion criteria.

For their review, the researchers defined efficacy outcomes as depression severity, cognition, and memory performance. Further, safety outcomes included serious adverse events such as suicide attempts or deaths.

In total, 340 patients were included in the review (162 for ECT and 178 for ketamine). The researchers found that the standardized mean difference in depression symptoms after ECT treatment was -0.69 (95% CI, -0.89 to -0.48); p = 0.15 when compared with ketamine treatment—an efficacy advantage for ECT compared with ketamine for depression severity.

Further, for studies that assessed cognition/memory or serious adverse events, there were no significant differences between ketamine and ECT.

The review included a few limitations such as most of the studies reviewed featured small sample sizes and lacked long-term follow-up assessments. Additionally, the authors note that studies had slightly different inclusion and exclusion criteria and may have used different ketamine and/or ECT treatment protocols.

“Findings from this systematic review and meta-analysis suggest that ECT may be superior to ketamine for improving depression severity in the acute phase, but treatment options should be individualized and patient-centered,” the researchers concluded.

 

Reference:

Rhee TG, Shim SR, Forester BP, et al. Efficacy and safety of ketamine vs electroconvulsive therapy among patients with major depressive episode. JAMA Psychiatry. 2022;79(12):1162-1172. doi:10.1001/jamapsychiatry.2022.3352