Mental Health | ECT treatment more effective for MDD than Ketamine

Mental health matters | Electroconvulsive therapy (ECT) was found to be a more effective major depressive episode treatment than ketamine,...

...though each treatment has its own set of unique adverse effects, according to a study published in JAMA Psychiatry.

“Significant differences were not observed between groups for studies that assessed cognition/memory or serious adverse events,” lead author Taeho Greg Rhee, PhD, Yale University, and co-authors noted. “Both ketamine and ECT had unique adverse effect profiles (ie, ketamine: lower risks for headache and muscle pain; ECT: lower risks for blurred vision, vertigo, diplopia/nystagmus, and transient dissociative/depersonalization symptoms).” 

Researchers analyzed data from studies that included 3 elements: a depression diagnosis using standardized diagnostic criteria, intervention/comparator groups with ECT and ketamine, and the use of depressive symptoms as an efficacy outcome using standardized measures. Efficacy and safety outcomes included memory performance, depression severity, and serious adverse events. The improvement in depression symptoms was measured using standardized mean differences (SMDs).

Under the guidelines set, 6 trials of 340 patients total were analyzed, all of which used patients eligible to receive ECT and took place in inpatient settings. Five studies were randomized clinical trials. The overall pooled SMD for depression symptoms for ECT when compared with ketamine was -0.69, giving ECT an advantage over ketamine for depression severity. There were no differences in memory/cognition or serious adverse events (such as suicide attempts or deaths) between groups.

“This meta-analysis suggests that ECT may be superior to ketamine for improving acute depression severity, but several major methodological limitations reported should be considered,” researchers concluded. “At least 2 large, ongoing comparative studies will lend further data on this important question that has significant relevance to patients, health care professionals, and policy makers.”

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