The New England Journal of MedicineKetamine versus ECT for Nonpsychotic Treatment-Resistant Major Depression

Decoding the Efficacy: Ketamine and ECT in the Battle Against Treatment-Resistant Depression

As you delve into the comparative effectiveness of ketamine and ECT, NEJM highlights the key findings from a recent noninferiority trial that could reshape your understanding of these treatments.

• The trial was an open-label, randomized, noninferiority study involving patients with treatment-resistant major depression.
• Patients were assigned to receive either ECT three times per week or ketamine twice per week over an initial 3-week treatment phase.
• The primary outcome was a response to treatment, defined as a ≥50% decrease from baseline in the Quick Inventory of Depressive Symptomatology–Self-Report score.
• A total of 403 patients were randomized, with 195 receiving ketamine and 170 receiving ECT after accounting for withdrawals.
• 55.4% of patients in the ketamine group and 41.2% in the ECT group responded to treatment, confirming ketamine’s noninferiority.
• ECT was associated with a decrease in memory recall after 3 weeks of treatment, with gradual recovery during follow-up.
• Both treatments showed similar improvements in patient-reported quality of life, but ECT was linked to musculoskeletal adverse effects, while ketamine was associated with dissociation.