Johns Hopkins MedicineJohns Hopkins Clinician-Scientists Participate in National Study on Ketamine vs. ECT for Treatment-Resistant Depression

Ketamine Shows Promise as an Effective Alternative to ECT for Treatment-Resistant Depression: A New Hope in Psychiatry

In a nationwide clinical trial, ketamine has emerged as a potential alternative to electroconvulsive therapy (ECT) for patients with treatment-resistant depression. This significant finding, reported in the New England Journal of Medicine, could herald a new era in the treatment of major depressive disorder, offering hope to millions who do not respond to traditional antidepressants.

Key Points:

• The clinical trial was a multisite study, including Johns Hopkins, sponsored by the Patient-Centered Outcomes Research Institute.
• The study compared the effectiveness of ECT and ketamine in 365 patients diagnosed with treatment-resistant major depressive disorder.
• Patients were randomly assigned to receive either ECT or sub-anesthesia doses of ketamine intravenously.
• By the end of the three-week treatment period, 55% of the ketamine group and 41% of the ECT group reported a 50% or greater reduction in symptoms.
• Six months later, quality-of-life scores for both groups were similar.
• The study suggests that a trial of ketamine is reasonable for those with moderate to severe depression before embarking on ECT.
• The researchers caution that the study’s findings may not apply to severely ill patients who are hospitalized.
• The researchers are preparing for another multisite comparison of the effectiveness of ketamine and ECT, this time focusing on patients with acute suicidal depression and bipolar depression.

“There’s standardization, the [ketamine] treatment is easy and well tolerated, with few side effects such as the memory loss that may accompany ECT treatment. In contrast, while there is increasing attention to standardizing the manner by which ECT is given to patients, there remains a fair amount of variability in clinical practice about what type of settings to use and when to switch, for example, to bilateral treatments.”

Fernando Goes, MD
Director of the Stanley and Elizabeth Star Precision Medicine Center of Excellence in Mood Disorders

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