ADVERTISEMENT
For Treatment-Resistant Depression, Ketamine and ECT Offer Similar Effectiveness
Seemingly contradictory findings from recent studies comparing intravenous (IV) ketamine with electroconvulsive therapy (ECT) in outpatients with treatment-resistant depression may have practicing clinicians feeling unsure about which treatment to recommend. However, evidence from the 2 noninferiority trials and two meta-analyses shows that ketamine and gold-standard ECT actually share similar efficacy, points out a recent column published in JAMA Psychiatry.
“[D]espite statistical analyses favoring one treatment or the other, all the described studies have shown that the short-term effectiveness of IV ketamine is close to that of ECT for treatment-resistant depression,” wrote corresponding author Sanjay J. Mathew, MD, of the Baylor College of Medicine in Houston, Texas, and coauthors. (The column’s second author Manish K. Jha, MBBS, of University of Texas Southwestern Medical Center, Dallas, Texas, serves as a Psych Congress Steering Committee Member.)
>>NEWS: Compass Pathways Initiates Phase 3 Study of Psilocybin for Treatment-Resistant Depression
ECT showed slightly better effectiveness than ketamine in a large European trial (Racemic Ketamine as an Alternative to Electroconvulsive Therapy for Unipolar Depression: a Randomized, Open-Label, Non-Inferiority Trial [KetECT]), published in 2022, and 2 meta-analyses published in 2022 and 2023, the authors reported. But the largest comparative effectiveness trial to date (Ketamine Versus ECT for Nonpsychotic Treatment-Resistant Major Depression, or ELEKT-D), published in 2023, concluded IV ketamine to be noninferior to ECT in US patients with treatment-resistant depression.
The viewpoint piece contextualized the investigations and their results.
“The clear clinical implication is that IV ketamine should be offered as an option within a shared decision-making approach for all patients being referred for ECT for treatment-resistant depression,” the authors wrote.
The piece also highlighted issues stemming from the studies, including a lack of evidence for how to best administer ketamine in the induction phase, as well as modest remission rates and high 6-month relapse rates for both treatments in ELEKT-D. Ultimately, novel and more effective treatments for treatment-resistant depression are needed.
“[T]hese recent studies underscore the messy truth that psychiatry’s most biological interventions involve multiple interpersonal, social, and economic factors that influence early, short-term, clinical outcomes,” the authors wrote. “Individuals with treatment-resistant depression and their clinicians should demand for developing more effective novel treatments and for personalized medicine approaches to guide currently available ones.”
Reference
