Efficacy and safety of ketamine vs. electroconvulsive therapy among patients with major depressive episode

By Scott Cunningham, MD, PhD
Published October 24, 2022

Key Takeaways

  • Based on a meta-analysis, electroconvulsive therapy (ECT) was shown to be superior to ketamine for acute depressive episodes.

Putting It Into Practice

ECT is considered by some to be the gold standard for patients with treatment-resistant depression. Nevertheless, ECT is underused by physicians for logistical reasons and is not well-accepted by patients.

Ketamine remains an option for treatment-resistant depression; however, ketamine is not approved for this indication.

Both ECT and ketamine are effective and well-tolerated with lasting effects and low remission rates.

Why this study matters

Nearly 30% of patients with major depressive disorder are treatment-resistant. CT and ketamine are effective, well-tolerated treatment options. As shown in the current meta-analysis, ECT is more effective in treating depression severity than ketamine.

Study design

The literature was searched for studies involving patients with major depressive disorder who were treated with ECT or ketamine. The primary outcomes included severity of depression, cognition, and memory performance. Adverse events were also recorded.

Results and conclusion

Six studies involving 340 patients were reviewed. ECT was shown to be more efficient in improving depression than ketamine, but no differences between the treatments were detected with respect to cognition, memory performance, or adverse effects.

Original Source

Rhee TG, Shim SY, Forester BP, et al. Efficacy and safety of ketamine vs. electroconvulsive therapy among patients with major depressive episode: A systematic review and meta-analysis. JAMA Psychiatry 2022; doi:10.1001/jamapsychiatry.2022.3352.

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