Comparative Effect of Intravenous Ketamine and Electroconvulsive Therapy in Major Depression: A Randomized Controlled Trial

Abstract

Background: Achieving a rapid onset and durable methods of treatment for major depressive disorders is an issue pursuing in psychiatry. This study was designed to assess the therapeutic efficacy of intravenous (IV) ketamine injection in controlling depressive symptoms in comparison with electroconvulsive therapy (ECT) in major depressed disordered patients. Materials and Methods: Thirty-two patients over 18 years of age who were candidates for ECT were enrolled in the study. They were allocated into two groups using block design randomization. Sixteen patients received IV infusion of 0.5-mg/kg ketamine and 16 patients underwent a bitemporal ECT. To evaluate the changes in depression severity, researchers administered Hamilton Depression Rating Scale (HDRS) at baseline, before each treatment session, and four time points posttreatment (week 1 and months 1, 2, and 3). The Wechsler Memory Scale was used to evaluate the cognitive state of patients in week 1, month 1, and month 3 of the treatment. Results: The HDRS showed improvement in depressive symptoms in both the groups with no statistically significant difference. Cognitive state was more favorable (but not significant) in the ketamine group ( P > 0.5). Conclusion: Treatment with IV ketamine in depressed people has the same antidepressant effects as ECT treatment without any memory deficiency.

The effect of ketamine on cognition, anxiety, and social functioning in adults with psychiatric disorders: A systematic review and meta-analysis

“…As shown in Figure 1 , from 856 records screened on title and abstract, 150 full texts were analyzed. The review process led to the selection of 22 studies (references reported in Table 1 ) referring to 22 independent RCTs (Loo et al, 2012 ; Zarate et al, 2012 ; Price et al, 2014 ; Rasmussen et al, 2014 ; Yoosefi et al, 2014 ; Alizadeh et al, 2015 ; Murrough et al, 2015 ; Singh et al, 2016 ; Zhong et al, 2016 ; Anderson et al, 2017 ; Fernie et al, 2017 ; Ray-Griffith et al, 2017 ; Chen et al, 2018 ; Taylor et al, 2018 ; Zhang et al, 2018 ; Dong et al, 2019 ; Fedgchin et al, 2019 ; Kheirabadi et al, 2019 ; Domany et al, 2020 ; Ochs-Ross et al, 2020 ; Keilp et al, 2021 ; Zou et al, 2021 ), 20 of these trials provided quantitative outcome data, therefore were included in the quantitative synthesis.…”

Ketamine Anesthesia in Electroconvulsive Therapy

“…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.…”

A randomized, crossover comparison of ketamine and electroconvulsive therapy for treatment of major depressive episodes: a Canadian biomarker integration network in depression (CAN-BIND) study protocol

“…Moreover, our group and others have reported cumulative antidepressant effects with repeated infusions that lead to increased patient response rates over time [10][11][12], with further prolongation with once-weekly maintenance infusions in previously treatment-resistant depression [10]. Overall, ketamine appears to yield higher response rates than other pharmacological treatment strategies for depression; however, only a few randomized controlled trials have directly compared ketamine with other antidepressant interventions [13,14].…”