Electroconvulsive therapy superior to ketamine for treatment of depression

Electroconvulsive therapy appeared to be superior to ketamine for improving depression severity in the acute phase, findings from a systematic review and meta-analysis published in JAMA Psychiatry showed.

Currently it is unknown whether ketamine is as effective as electroconvulsive therapy (ECT) among patients with major depressive disorder; it is also not approved by regulatory agencies such as the FDA for treatment of depression, Taeho Greg Rhee, PhD, of the department of psychiatry at Yale School of Medicine, and colleagues wrote.

Rhee and colleagues sought to systematically review and meta-analyze data on the clinical efficacy and safety for ketamine and ECT in those with major depressive episodes.

The researchers used PubMed, MEDLINE, the Cochrane Library and Embase to include six clinical trials of 340 patients. To be included in this evaluation, the study inclusion needed a diagnosis of depression using standardized diagnostic criteria; intervention groups consisting of ECT and ketamine; and depressive symptoms as an efficacy outcome using standardized measures.

Of the 340 patients, 162 received ECT, and 178 received ketamine. The overall pooled standardized mean differences for depressive symptoms for ECT when compared with ketamine was –0.69 (95% CI, –0.89 to –0.48), which suggests an efficacy advantage for ECT compared with ketamine, Rhee and colleagues wrote.

“Findings from this systematic review and meta-analysis suggest that ECT may be superior to ketamine for improving depression severity in the acute phase, but treatment options should be individualized and patient-centered,” they wrote.