New Literature Review/Meta-Analysis of ECT vs Ketamine

 Out on PubMed, from authors in Brazil and Texas, is this review:

Efficacy and adverse effects of ketamine versus electroconvulsive therapy for major depressive disorder: A systematic review and meta-analysis.

de A Simoes Moreira D, Gauer LE, Teixeira G, da Silva AC, Cavalcanti S, Quevedo J.J Affect Disord. 2023 Mar 10:S0165-0327(23)00324-5. doi: 10.1016/j.jad.2023.02.152. Online ahead of print.PMID: 36907464 Review.

The abstract is copied below:

Background: ECT is considered the fastest and most effective treatment for TRD. Ketamine seems to be an attractive alternative due to its rapid-onset antidepressant effects and impact on suicidal thoughts. This study aimed to compare efficacy and tolerability of ECT and ketamine for different depression outcomes (PROSPERO/CRD42022349220).

Methods: We searched MEDLINE, Web of Science, Embase, PsycINFO, Google Scholar, Cochrane Library and trial registries, which were the ClinicalTrials.gov and the World Health Organization's International Clinical Trials Registry Platform, without restrictions on publication date.

Selection criteria: randomized controlled trials or cohorts comparing ketamine versus ECT in patients with TRD.

Results: Eight studies met the inclusion criteria (of 2875 retrieved). Random-effects models comparing ketamine and ECT regarding the following outcomes were conducted: a) reduction of depressive symptoms severity through scales, g = -0.12, p = 0.68; b) response to therapy, RR = 0.89, p = 0.51; c) reported side-effects: dissociative symptoms, RR = 5.41, p = 0.06; nausea, RR = 0.73, p = 0.47; muscle pain, RR = 0.25, p = 0.02; and headache, RR = 0.39, p = 0.08. Influential & subgroup analyses were performed.

Limitations: Methodological issues with high risk of bias in some of the source material, reduced number of eligible studies with high in-between heterogeneity and small sample sizes.

Conclusion: Our study showed no evidence to support the superiority of ketamine over ECT for severity of depressive symptoms and response to therapy. Regarding side effects, there was a statistically significant decreased risk of muscle pain in patients treated with ketamine compared to ECT.

Keywords: ECT; Ketamine; MDD; Meta-analysis; Mood disorders; TRD.

Some of the text is copied below:

Here's a new literature review comparing ECT and ketamine. The role of ketamine in treating serious depression remains to be determined; let us remember the 80-plus-year history of ECT's efficacy and safety compared to the small, but accumulating, track record for ketamine. Literature reviews obviously do not reflect the clinical reality that urgently ill patients need to be referred for consideration of ECT without delay.


Comments

Post a Comment

Popular posts from this blog

ECT vs Ketamine: NEJM Article Sets Up False Equivalency

Image
Out on PubMed, from investigators in the US, is this study: Ketamine versus  ECT   for Nonpsychotic Treatment-Resistant Major Depression. Anand A, Mathew SJ, Sanacora G, Murrough JW, Goes FS, Altinay M, Aloysi AS, Asghar-Ali AA, Barnett BS, Chang LC, Collins KA, Costi S, Iqbal S, Jha MK, Krishnan K, Malone DA, Nikayin S, Nissen SE, Ostroff RB, Reti IM, Wilkinson ST, Wolski K, Hu B. N Engl J Med. 2023 May 24. doi: 10.1056/NEJMoa2302399. Online ahead of print. PMID:  37224232 The abstract is copied below: Background:  Electroconvulsive therapy (ECT) and subanesthetic intravenous ketamine are both currently used for treatment-resistant major depression, but the comparative effectiveness of the two treatments remains uncertain. Methods:  We conducted an open-label, randomized, noninferiority trial involving patients referred to ECT clinics for treatment-resistant major depression . Patients with treatment-resistant major depression without psychosis were recruited and assigned in a 1:1 rat
Read more

RUL ECT vs Low Amplitude Seizure Therapy (LAP-ST)

Image
Out on PubMed, from the team in Augusta, Georgia, is this study: Double-Blinded Randomized Pilot Clinical Trial Comparing Cognitive Side Effects of Standard Ultra-Brief Right Unilateral ECT to 0.5 A Low Amplitude Seizure Therapy (LAP-ST). Youssef NA, McCall WV, Ravilla D, McCloud L, Rosenquist PB. Brain Sci. 2020 Dec 13;10(12):E979. doi: 10.3390/brainsci10120979. PMID:  33322138 The pdf is here . And from the Introduction : In theory, LAP-ST can be helpful because of the direct effect of lower electric current, but the principal reason is that LAP-ST has a more focal electric field (EF) [ 34 , 35 ]. The current amplitude is the primary factor that drives the EF into brain regions located deeper in the brain and is responsible for cognition and memory such as the hippocampus and temporal lobe [ 33 , 35 ]. This extra focality of the EF can minimize or avoid high EF stimulation to the deeper hippocampal and temporal lobe regions [ 33 , 35 ]. Minimization of deeper stimulation by using LAP
Read more

ECT For Children at a University Hospital: New Study in JECT

Image
 Out on PubMed, from authors at Vanderbilt and Mass General,, is this article: Use of   ECT   for Children With and Without Catatonia: A Single-Site Retrospective Analysis. Smith JR, Baldwin I, Termini KA, McGonigle T, Vandekar S, Luccarelli J. J ECT. 2024 Jan 25. doi: 10.1097/YCT.0000000000000993. Online ahead of print. PMID:  38265759 The abstract is copied below: Objectives: The objective study was to investigate the safety and efficacy of electroconvulsive therapy (ECT) in a retrospective cohort of pediatric patients. Methods: A single-site retrospective analysis was conducted of patients aged younger than 18 years who received ECT in a private university hospital from January 28, 2012 to April 8, 2023. Treatment efficacy and adverse events were determined retrospectively through review of the medical record. Results: A total of 36 pediatric patients met the inclusion criteria. Catatonia was the most common presenting indication for ECT, followed by psychosis and suicidal ideation.
Read more