Antidepressant effects of ketamine and ECT: A pilot comparison

Sharma, Ravi; Kulkarni, Gajanan; Kumar, Channaveerachari Naveen; Arumugham, Shyam Sundar; Venkataramaiah, Sudhir; Mehta, Urvakhsh Meherwan; Mitra, Sayantanava; Thanki, Milind Vijay; Thirthalli, Jagadisha

doi:10.1016/j.jad.2020.07.066

Cited by 22 publications

(17 citation statements)

References 31 publications

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“…Five RCTs (pooled N = 278) met our search criteria (Figure 1 and eTable 1 in Supplement 1). In the main analysis, posttreatment depression ratings showed a trend for lower scores with ECT compared with ketamine (SMD, −0.39; 95% CI, −0.81 to 0.02; I 2 = 45%; 5 RCTs; n = 278) (Figure 2). Importantly, in a sensitivity analysis that specifically excluded 3 RCTs for reasons related to questionable methods and reporting, described in detail in our earlier review, posttreatment depression ratings in the remaining RCTs were significantly lower with ECT than with ketamine (SMD, −0.45; 95% CI, −0.75 to −0.14; I 2 = 6%; 2 RCTs; n = 211) (Figure 3).…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…The pooled ECT vs ketamine RR was 1.27 (95% CI, 1.06-1.53; I 2 = 0%; 3 RCTs; n = 229) (eFigure 1 in Supplement 1) for a study-defined response rate and 1.43 (95% CI, 1.12-1.82; I 2 = 0%; 2 RCTs; n = 211) (eFigure 2 in Supplement 1) for a study-defined remission rate. ECT was significantly superior to ketamine in both regards, and heterogeneity was low in both analyses.…”

Section: Resultsmentioning

confidence: 99%

“…We sought additional relevant data, not presented in their articles, from all authors but received the requested data only from Ekstrand et al and Sharma et al We used version 2 of the Cochrane risk-of-bias tool for RCTs to assess risk of bias. Two authors (N.V. and A.F.)…”

Section: Methodsmentioning

confidence: 99%

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Ketamine vs Electroconvulsive Therapy for Major Depressive Episode

et al. 2023

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ImportanceThe relative efficacy of ketamine and electroconvulsive therapy (ECT) in adults with major depressive episode (MDE) needs clarification.ObjectiveTo compare depression rating outcomes with ketamine vs ECT in adults with MDE and to compare response and remission rates, number of sessions to response and remission, and adverse effects.Data SourcesTwo investigators independently systematically searched MEDLINE, ScienceDirect, and Google Scholar databases using a combination of relevant Medical Subject Headings terms and free-text keywords from database inception through May 15, 2022, to identify relevant English-language trials.Study SelectionParallel-group randomized clinical trials (RCTs).Data Extraction and SynthesisTwo investigators independently extracted data and assessed risk of bias. One-week posttreatment outcomes were pooled as standardized mean difference (SMD; Hedges g) for continuous outcomes and risk ratio (RR) for categorical outcomes in random-effects meta-analyses.Main Outcomes and MeasuresEfficacy outcomes were 1-week (or nearest) posttreatment depression ratings, 1-week (or nearest) study-defined response and remission rates, and number of sessions to treatment response and remission. Safety outcomes were reported adverse effects.ResultsFive trials (ketamine group: n = 141; ECT group: n = 137) were meta-analyzed. The overall pooled SMD for posttreatment depression ratings was −0.39 (95% CI, −0.81 to 0.02; I2 = 45%; 5 RCTs). For this efficacy outcome, in a sensitivity analysis of methodologically stronger trials, ECT was superior to ketamine (SMD, −0.45; 95% CI, −0.75 to −0.14; I2 = 6%; 2 RCTs). ECT was also superior to ketamine for study-defined response (RR, 1.27; 95% CI, 1.06-1.53; I2 = 0%; 3 RCTs) and remission (RR, 1.43; 95% CI, 1.12-1.82; I2 = 0%; 2 RCTs) rates. 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.Conclusion and RelevanceThe findings of this systematic review and meta-analysis suggest an efficacy advantage for ECT over ketamine in adults with MDE. These conclusions are tempered by the small number and size of existing trials.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Ketamine vs Electroconvulsive Therapy for Major Depressive Episode

et al. 2023

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“…There are six papers at present [37]. While randomized control trials [38][39][40] are discussed in three papers, the other three cover open-label trials [41][42][43]. The results suggest that ketamine therapy develops antidepressant effects more quickly than ECT, but perhaps the effect is not sustained compared with ECT.…”

Section: Ketamine As An Alternative To Ectmentioning

confidence: 99%

Ketamine Anesthesia in Electroconvulsive Therapy

Satomoto¹

2022

Ketamine Revisited - New Insights Into NMDA Inhibitors

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Electroconvulsive therapy (ECT) is highly effective both Major Depressive Disorder (MDD) and Bipolar Disorder (BD). Ketamine, an antagonist of the N-Methyl-D-aspartate receptor, has been described to have antidepressant properties. There is a hypothesis that ECT performed with anesthesia using ketamine is more effective than conventional ECT. Also, although ECT is the gold standard for BD and MDD, there are questions about which is more effective, ketamine treatment or ECT, and whether ketamine is more effective when used in combination with ECT. In this chapter, we review the current literature on the effectiveness of ECT and ketamine. Furthermore, we discuss whether ketamine can be an alternative treatment to ECT for patients with TRD.

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Efficacy and Safety of Ketamine vs Electroconvulsive Therapy Among Patients With Major Depressive Episode

et al. 2022

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ImportanceWhether ketamine is as effective as electroconvulsive therapy (ECT) among patients with major depressive episode remains unknown.ObjectiveTo systematically review and meta-analyze data about clinical efficacy and safety for ketamine and ECT in patients with major depressive episode.Data SourcesPubMed, MEDLINE, Cochrane Library, and Embase were systematically searched using Medical Subject Headings (MeSH) terms and text keywords from database inception through April 19, 2022, with no language limits. Two authors also manually and independently searched all relevant studies in US and European clinical trial registries and Google Scholar.Study SelectionIncluded were studies that involved (1) a diagnosis of depression using standardized diagnostic criteria, (2) intervention/comparator groups consisting of ECT and ketamine, and (3) depressive symptoms as an efficacy outcome using standardized measures.Data Extraction and SynthesisData extraction was completed independently by 2 extractors and cross-checked for errors. Hedges g standardized mean differences (SMDs) were used for improvement in depressive symptoms. SMDs with corresponding 95% CIs were estimated using fixed- or random-effects models. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed.Main Outcomes and MeasuresEfficacy outcomes included depression severity, cognition, and memory performance. Safety outcomes included serious adverse events (eg, suicide attempts and deaths) and other adverse events.ResultsSix clinical trials comprising 340 patients (n = 162 for ECT and n = 178 for ketamine) were included in the review. Six of 6 studies enrolled patients who were eligible to receive ECT, 6 studies were conducted in inpatient settings, and 5 studies were randomized clinical trials. The overall pooled SMD for depression symptoms for ECT when compared with ketamine was −0.69 (95% CI, −0.89 to −0.48; Cochran Q, P = .15; I2 = 39%), suggesting an efficacy advantage for ECT compared with ketamine for depression severity. Significant differences were not observed between groups for studies that assessed cognition/memory or serious adverse events. Both ketamine and ECT had unique adverse effect profiles (ie, ketamine: lower risks for headache and muscle pain; ECT: lower risks for blurred vision, vertigo, diplopia/nystagmus, and transient dissociative/depersonalization symptoms). Limitations included low to moderate methodological quality and underpowered study designs.Conclusions and RelevanceFindings 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.

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Antidepressant effects of ketamine and ECT: A pilot comparison

Cited by 22 publications

References 31 publications

Ketamine vs Electroconvulsive Therapy for Major Depressive Episode

Ketamine vs Electroconvulsive Therapy for Major Depressive Episode

Ketamine Anesthesia in Electroconvulsive Therapy

Efficacy and Safety of Ketamine vs Electroconvulsive Therapy Among Patients With Major Depressive Episode

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