Swedish Commentary on ECT vs Ketamine Studies

Out on PubMed, from Swedish investigators, is this article:

Vi förutspår ingen revolution inom depressio

nssjukvården.

(We don't predict a revolution in depression care)

Nordenskjöld A, Movahed P.Lakartidningen. 2023 Nov 15;120:23149.PMID: 37966105 Swedish. No abstract available.

The article is here:

https://lakartidningen.se/klinik-och-vetenskap-1/kommentar/2023/11/vi-forutspar-ingen-revolution-inom-depressionssjukvarden/

Text excerpts are translated below:


Major depression is associated with very low quality of life, long-term cognitive impairment and an increased risk of death by suicide. Electroconvulsive therapy (ECT) is the most effective treatment for major depression. ECT involves inducing epileptic seizures with an electric current under general anesthesia. The treatment was introduced in the 1930s, but drug-induced seizures had already been used to treat depression for a long time. The mechanisms of action are thought to include the regeneration of brain cells and nerve cell connections. Its use is limited both by the fact that memory impairment is a common side effect of ECT and by the need for general anesthesia. In addition, there is excessive fear based on prejudice

Translated with www.DeepL.com/Translator (free version)

...

Thus, the differences between the studies were not due to different treatment outcomes of ketamine, but because the results after ECT were particularly poor in ELEKT-D. The authors of ELEKT-D respond to the criticism by saying that the results are similar to those achieved after ECT in routine care in the US [3, 4]. It may seem surprising that five American hospitals, including Yale, Johns Hopkins and Mount Sinai, report a remission rate after ECT that is barely half (22%) of that reported by the Quality Register ECT in 2022 (50%). None of 47 Swedish hospitals reported a remission rate below 31%. Thus, we in Sweden can be proud of the employees at our ECT units who provide ECT of international top class, probably partly thanks to a strong tradition. The late Jan-Otto Ottosson had a significant impact on the development of ECT.

...

One also needs to be aware that it is unclear whether ketamine reduces the risk of suicide attempts or completed suicides, while ECT has been shown to reduce both suicide attempts and completed suicides.

...

Depression is a heterogeneous disease with likely varying biological causes. In the future, we hope that genetic or biochemical tests, in combination with other information, will be able to tell us whether antidepressants, psychological treatment, ketamine, ECT, rTMS, or perhaps something else entirely, will benefit an individual patient. Finding markers in the future that predict different effects of different treatments could lead to major changes, but we don't foresee a revolution in depression care because of the recent findings on ketamine.

Translated with www.DeepL.com/Translator (free version)

Here is a continuation of the discussion of the two recent clinical trials comparing ECT and IV ketamine; this piece is in a lay, Swedish medical magazine.

The main points here are the anomalous ECT results in the American trial, and contexualizing for whom ketamine may be a reasonable option.

Kudos to Axel and Pouya for educating the public about the continuing role of ECT in the standard treatment of severe depression.