Ketamine Versus ECT for the Treatment of Depression: A Guide for Clinicians

 Out on PubMed,  from authors at Yale University, is this paper:

Ketamine Versus Electroconvulsive Therapy for the Treatment of Depression: A Guide for Clinicians.

Elliott SI, B Katz R, B Ostroff R, Ansari M, Holmes SE, Sanacora G.Focus (Am Psychiatr Publ). 2025 Apr;23(2):195-205. doi: 10.1176/appi.focus.20240040. Epub 2025 Apr 15.PMID: 40235610

The paper is here.

And from the text:

There is little information to suggest that ECT could increase risk of substance use disorder. 

Huh?

Adverse effects such as prolonged apnea or prolonged paralysis, caused by the muscle relaxants given during ECT, and seizure-related adverse effects such as prolonged seizures and tardive seizures are more serious but rare.

Because of the muscle contractions induced during ECT, severe osteoporosis could be a risk factor for fractures during treatment, and ketamine might be a safer treatment if adequate paralysis cannot be achieved 

Sure. True, but why even bring up these rare events in a review? 

You can almost feel the authors trying to be fair in this comparison, but in the end they fail and their ketamine bias (see also disclosures, below) leaks through. The "Box1" summary is a bit redeeming, however, compared to the text.

I was hoping for some clinical wisdom here, something like, "for urgent clinical situations, ECT has a vast clinical evidence base...", but this paper ends up being clinically tone deaf and not much of a "guide for clinicians" at all.

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