ECT as good, if not better, as ketamine for depression

2 minute read

A new review shows a small advantage with ECT, but with only five trials in the mix, the jury’s still out.

Electroconvulsive therapy (ECT) may be superior to ketamine in adults with a major depressive episode, according to a new systematic review and meta-analysis. 

Published in JAMA Psychiatry, the review authors were cautious in their conclusions, noting that only five randomised clinical trials met the search criteria, with a total number of 278 participants (141 in the ketamine group, and 137 in the ECT group). 

Primary outcomes for the review were one week (or nearest) post-treatment depression ratings, one week (or nearest) study-defined response and remission rates, and number of sessions to treatment response and remission.  

The authors reported that when they analysed the strongest trials, ECT was superior to ketamine. It was 27% more likely to beat ketamine in study-defined response and 43% more likely to beat ketamine in achieving remission. 

“No significant differences were noted between groups for number of sessions to response and remission and for cognitive outcomes. Key limitations were small number of studies, limited sample size, and high risk of bias in all trials,” the authors wrote.  

In two reviews, after a sensitivity analysis, post-treatment depression ratings were significantly lower with ECT than with ketamine.  

“Overall, ECT, compared with ketamine, was not associated with statistically significantly lower depression scores one week post-treatment; however, in a sensitivity analysis that excluded RCTs with questionable methods and reporting, ECT was associated with significantly lower depression scores post-treatment,” the authors wrote. 

“Importantly, ECT was associated with significantly higher response and remission rates but not with significantly faster onset of either response or remission.” 

Despite the results, the authors wrote that for some patients who wanted to avoid cognitive risks, “a trial of ketamine may be worth considering before a trial of ECT”. 

JAMA Psychiatry 2023, online 12 April

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