Pioneering Study Offers Insight on Depression Treatment: Ketamine vs ECT

Key Points

• Are there baseline clinical aspects associated with greater improvement in treatment-resistant depression using ketamine versus electroconvulsive therapy (ECT)?
• Adults with non-psychotic treatment-resistant depression, needing less severe intervention, benefit more with ketamine over ECT.
• Very severe cases see more rapid improvement with ECT, but end-of-treatment results show little difference between the two.

A recent analysis of the ELEKT-D randomized clinical trial has unpacked potential guidance for choosing between ketamine infusions and electroconvulsive therapy (ECT) for patients with treatment-resistant depression (TRD). While both treatments were shown to be effective, this detailed study provides critical insights that may help clinicians and patients decide on the most suitable course of action.

Study Design

The research, conducted in multiple academic centers in the US, enrolled patients aged 21 to 75 with moderate to severe TRD. Controlled treatments included either ketamine infusions or ECT sessions over a three-week period. Various patient characteristics were examined to see how they influenced response rates to the treatments.

Outcomes Observed

For those with moderately severe depression or receiving treatment as outpatients, ketamine was notably more effective than ECT. Surprisingly, individuals with higher premorbid intelligence or a concurrent posttraumatic stress disorder diagnosis reported greater reductions in the depression rating scale if they received ECT.

Implications for Treatment

The results suggest that ketamine might be a preferred treatment over ECT for outpatients and those not at the highest severity of depression. Importantly, premorbid intelligence and concomitant psychiatric diagnosis add more pieces to this complex puzzle of personalized treatment.

Limitations and Future Research

Despite robust findings, there are limitations due to the selection criteria, potential underpower of the analysis, and absence of biomarkers, which could inform the treatment pathways on an individual level. Further research is needed before these insights translate into routine clinical practice.

For patients and doctors wading through the daunting choices for tackling TRD, this study marks a significant stride toward customized care plans that could greatly enhance overall outcomes and quality of life.

The full study's details are accessible open access under the CC-BY License, thanks to JAMA Network Open.

To learn more about the study, visit the JAMA Network Open article: Ketamine vs Electroconvulsive Therapy for Treatment-Resistant Depression.

This research summary was built with the help of Buoy Health.