Ketamine vs ECT: Viewpoint in JAMA Psychiatry

 Out on PubMed, from American authors, is this commentary:

Choosing Between Ketamine and Electroconvulsive Therapy for Outpatients With Treatment-Resistant Depression-Advantage Ketamine?

Mathew SJ, Jha MK, Anand A.JAMA Psychiatry. 2023 Oct 25. doi: 10.1001/jamapsychiatry.2023.3979. Online ahead of print.PMID: 37878334

Plain language summary (in lieu of abstract):

This Viewpoint examines key issues stemming from several recent reports of electroconvulsive therapy (ECT) vs ketamine for improving depressive symptoms in treatment-resistant depression (TRD).

The paper is here.

And here:

My "plain language summary" is that this is largely pie-in-the-sky: the conflated false equivalency of a treatment with a nearly 100-year track record (ECT) with another, still experimental treatment (ketamine) based on two recent clinical trials.

I take particular umbrage at the title and the beginning of the "Conclusions." How many thousands of patients will have their clinical management derailed and delayed because they "should" consider a trial of IV ketamine before ECT? You say the corollary question is how many thousands of patients will be spared a course of ECT? Well, the answer is that most of those courses of ECT would have been safe, effective, and well tolerated. 

Ketamine is a very interesting and potentially useful therapy in a subset of depressed patients; to call it on a "par" with ECT "for outpatients with TRD" is premature and potentially misleading.