More successful than ketamine – shock treatment for depression

Electroconvulsive therapy, which is portrayed unfavorably in movies and TV shows, consistently produces better results for intractable depression.

According to an analysis of six studies that recently published their results in JAMA Psychiatryelectroconvulsive therapy (ECT) is better than ketamine for rapid relief of major depression.

According to the World Health Organization, depression is a widespread illness that affects approximately 5% of people worldwide (WHO). Feeling sad, irritable, losing pleasure in previously wonderful things, and even enduring unexplained pain or fatigue for weeks on end are all signs of depression. The most common first-line treatment for depression is the use of oral antidepressants (in combination with psychotherapy). However, when oral antidepressants are ineffective or when the patient is in immediate danger of self-harm, there are other, more rapid treatment options, including ECT and, more recently, ketamine or esketamine.

Ketamine is used less frequently in the US than esketamine, a nasal spray that has been approved by the Food and Drug Administration to treat depression. However, there are no studies comparing the effectiveness of ECT with esketamine. Ketamine, a sister drug to esketamine, was investigated. Ketamine is commonly used as an injectable anesthetic in medicine, but it has recently been studied as a quick-acting intervention to help those suffering from major depression.

T. Greg Rhee, psychiatrist-epidemiologist with Connecticut State University Medical school, and associates of Harvard UniversityGyeongnam University in Korea, McLean Hospital and Massachusetts General Hospital in boston University of TorontoVA New England Mental Illness in West Haven, and Yale University reviewed six global clinical trials comparing ketamine and ECT in major depression. 340 patients participated in the trials, which were conducted in hospitals in Sweden, Germany, Iran and India.

All six studies independently found that ECT was more effective than ketamine in alleviating severe depressive symptoms.

“EST is consistently more successful in helping patients with major depression than ketamine,” Rhee says. “We found no differences by age, gender, or geographic location. So we can say that everyone who is eligible for ECT will benefit.”

Although ketamine generally helped patients, ECT had better results overall. Ketamine may be a viable treatment for people who cannot undergo ECT. The side effect profiles of the two treatments differed: ECT was more likely to cause headache, muscle pain, and memory loss, while ketamine was more likely to cause dissociative symptoms, dizziness, and diplopia.

Two additional studies comparing ECT and ketamine are ongoing, and Rhee hopes to add their data to the analysis as they become available.

“Every study directly reports that ECT works better than ketamine. But people are still skeptical about ECT, maybe because of the stigma,” says Rhee, or negative portrayals in movies like One Flew Over the Cuckoo’s Nest and shows like Stranger Things. “We need to increase public awareness of ECT for treatment-resistant depression.”

Reference: “Efficacy and Safety of Ketamine versus Electroconvulsive Therapy Among Patients with a Major Depressive Episode: A Systematic Review and Meta-Analysis” by Taeho Greg Rhee, Ph.D., Sung Ryul Shim, Ph.D., Brent P. Forrester, M.D., M.Sc., Andrew A. Nirenberg, MD, Roger C. McIntyre, MD, George I. Papacostas, MD, John H. Crystal, MD, Gerard Sanacora, MD, PhD. and Samuel T. Wilkinson, MD, October 19, 2022. JAMA Psychiatry.
DOI: 10.1001/jamapsychiatry.2022.3352