Ketamine and ECT Equally Effective for Treatment-Resistant Depression

An open-label, randomized, noninferiority trial published in the New England Journal of Medicine revealed that ketamine and electroconvulsive therapy (ECT) were equally effective at managing treatment-related depression (TRD).

According to the Mayo Clinic, ECT is a complicated procedure done under anesthesia. Clinicians deliver electrical currents to the brain, which has proven to improve symptoms of mental illness in some patients.

The study recruited 403 patients across five clinical sites referred for ECT to manage their TRD. Roughly half of the patient population was assigned to three ECT treatments per week. In contrast, half of the participants were given ketamine therapy at a concentration of 0.5 mg/kg of body weight twice a week. The ketamine therapy was delivered intravenously over 40 minutes.

Both participant groups were assigned to this treatment for three weeks. Before treatment, clinicians conducted a baseline assessment of depression using the Quick Inventory of Depressive Symptomology self-report.

According to the study, 55.4% of the ketamine participants responded to the treatment with a decline in their depression score. Comparatively, 41.2% of patients who had ECT therapy improved after treatment.

Despite treatment efficacy, the researcher noted some adverse reactions linked to ECT therapy, including initial issues in memory recall and musculoskeletal adverse events. However, ketamine therapy was also linked to unfavorable side effects, including dissociation.

Even with the reported side effects, patients maintained that the treatment improved their quality of life and helped manage some depression symptoms. There was no notable difference between the reports of improved quality of life.

The researchers in the study concluded, “ketamine was non-inferior to ECT as therapy for treatment-resistant major depression without psychosis.”

Although both treatments seem to have similar effects, determining the proper depression treatment can be a complicated and lengthy process. Before transitioning to higher-level therapies, most patients use less invasive options, such as selective serotonin reuptake inhibitors. Additional research is necessary to determine the best candidates for ECT and ketamine therapy.