Electroconvulsive therapy (ECT) may improve acute depression severity compared with ketamine, although treatment decisions should still be individualized and patient centered, according to a meta-analysis published yesterday in JAMA Psychiatry.
“[ECT] is considered the gold standard treatment for [treatment-resistant depression] because of its proven high efficacy,” wrote Taeho Greg Rhee, Ph.D., of Yale University School of Medicine and colleagues. However, several barriers—including few professionals trained in ECT delivery, stigma, and fears of side effects—have led to underuse of the technology.
Rhee and colleagues searched PubMed, MEDLINE, the Cochrane Library, and Embase for literature about clinical trials that included patients with a diagnosis of depression who were separated into groups receiving ECT or ketamine. The studies measured the severity of participants’ depressive symptoms using the Montgomery-Åsberg Depression Rating Scale, the Hamilton Depression Rating Scale, or the Beck Depression Inventory. The studies also evaluated safety-related events, including reports of headache, nausea, or dissociative symptoms.
Six studies were included with 340 participants, 162 of whom received ECT and 178 received ketamine. ECT was superior to ketamine across all three measures for depressive symptoms. Participants who received ketamine had lower risks for headaches compared with those who received ECT, though transient dissociative or depersonalization symptoms were more common among patients who received ketamine. ECT was associated with lower risks of blurred vision and vertigo compared with ketamine. The authors noted, however, that among some of the studies, ketamine appeared to have faster antidepressant effects for patients compared with ECT.
“Future research should assess long-term adverse events resulting from either ketamine or ECT and weigh the potential long-term benefits and risks of these treatment options,” the authors concluded.
For related information, see the Psychiatric News article “ECT for Depression May Cut Suicide Risk by Nearly 50%.”
(Image: iStock/Hank Grebe)
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