Psychiatry AdvisorKetamine vs ECT: Which Therapy is More Effective for Depression?

Comparing Ketamine and Electroconvulsive Therapy (ECT) in Treating Depression: Efficacy, Safety, and Practical Considerations

Recent findings presented at the 2024 American Psychiatric Association (APA) Annual Meeting reveal that ketamine and electroconvulsive therapy (ECT) show comparable efficacy in treating major depressive disorder (MDD). However, ketamine did not prove non-inferior to ECT for major depressive episodes (MDEs). The studies also highlight differences in side effect profiles and practical implications for clinical practice, emphasizing the need for further research to refine treatment guidelines.

Key Points:

• Comparison of Therapies: Both ketamine and ECT are effective for treating MDD, but ketamine is not non-inferior to ECT for MDEs.
• Study Context: Findings were presented at the APA 2024 Annual Meeting.
• Current Guidelines: ECT is the standard treatment for MDE but has limited accessibility and higher cognitive impairment risks.
• Availability and Safety: Ketamine is more accessible and has fewer adverse cognitive effects compared to ECT.
• Systematic Reviews and Meta-Analyses:
  • First Review: Included six trials with 655 patients; ketamine did not meet the noninferiority margin compared to ECT for MDE.
  • Second Review: Also included six trials; both treatments showed similar efficacy for MDD.
• Efficacy and Side Effects:
  • Ketamine: Outperformed ECT in post-treatment cognition scores.
  • ECT: Lower risk for dissociative or depersonalization symptoms; higher risk for cognitive impairment and muscle pain.
  • Overall Safety: No significant differences in the risk of adverse events between ketamine and ECT.
  • Specific Risks:
    • Ketamine: Lower risk for muscle pain but higher risk for dissociation or depersonalization.
    • ECT: Lower risk for dissociative symptoms but higher risk for cognitive impairment.
• Patient Demographics: Studies primarily involved middle-aged patients (average age 47), with a nearly equal distribution of genders and treatment settings.
• Treatment Duration and Follow-Up: Ranged from 1 to 3 weeks, with follow-up periods varying from 2 weeks to 13 months.
• Subgroup Analysis: ECT favored in patients with psychotic features; ketamine’s noninferiority not supported in inpatient settings.
• Future Directions: Calls for large-scale RCTs to further investigate side effect profiles and efficacy of ketamine vs. ECT in treating depression.

“In light of these findings, further large-scale RCTs should be conducted to investigate the side effect profile of ECT compared to ketamine as well as the efficacy of these two interventions in the treatment of depression.”

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