Ketamine vs ECT: Another Review

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

Ketamine versus electroconvulsive therapy for major depressive episode: An updated systematic review and non-inferiority meta-analysis.

Petrucci ABC, Fernandes JVA, Reis IA, da Silva GHS, Recla BMF, de Mendonça JC, Pedro VCS, D'Assunção LEN, Valiengo LDCL.Psychiatry Res. 2024 May 31;339:115994. doi: 10.1016/j.psychres.2024.115994. Online ahead of print.PMID: 38865906 Review.

The abstract is copied below:

We conducted a systematic review and meta-analysis to investigate the comparative effectiveness of ketamine versus electroconvulsive therapy (ECT) for the treatment of major depressive episodes (MDEs). PubMed, EMBASE and Cochrane Library databases were systematically searched for randomized controlled trials (RCTs) comparing ketamine and ECT for MDE. The primary outcome was response rate, for which we prespecified a non-inferiority margin of -0.1, based on the largest and most recent RCT. Response was defined as a reduction of at least 50 % in the depression scale score. Six RCTs met the inclusion criteria, comprising 655 patients. In the overall population, ketamine was not non-inferior to ECT in response rate (RD -0.10; 95 % CI -0.26 to 0.05; p = 0.198; I2 = 72 %). The ECT group had a higher reduction in depression scores, but without difference in remission and relapse rates. Regarding safety outcomes, ketamine had better posttreatment cognition scores and reduced muscle pain rate compared with ECT, albeit with an increased rate of dissociative symptoms. In a subanalysis with only inpatients, ketamine was inferior to ECT in response rate (RD -0.15; 95 % CI -0.27 to -0.03; p = 0.014; I2 = 25 %), remission, and change in depression scores. These findings support the use of ECT over ketamine for inpatients. Further RCTs are warranted to clarify the comparative effect of these treatments for outpatients.

Keywords: Anesthetic; Antidepressant; Depression; Electroconvulsive therapy; Ketamine; Major depressive disorder; Mood disorders.

The article is here.
And from the text:







How many negatives make a positive (...did not show non-inferiority...") ?
Well, at least this review is not empty cheerleading for ketamine with peremptory dismissal of ECT.
The inpatient/outpatient distinction and the exclusion of patients with psychotic depression (both markers of severity) are well worth noting.
Let's remember that ECT has a lengthy track record of safety and efficacy, and a vast evidence base to support its use.  


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