Journal Article Annotations
2022, 4th Quarter
Annotations by Liliya Gershengoren, MD
This study found that ECT was more efficacious than ketamine in reducing depression severity. The meta-analysis demonstrates that although ECT may be superior in reducing depressive symptoms to ketamine, it is important to consider ketamine’s faster antidepressant effects for patients with a severe MDE. The systematic review found one study which had a 12-month follow up period, which showed that remission rates were not different between groups. Both ketamine and ECT are known to have unique adverse effect profiles (ie, ketamine had lower risks for headache and muscle pain whereas ECT had lower risks for blurred vision, vertigo, diplopia/ nystagmus, and dissociative or depersonalization symptoms). However, there were no studies assessing the relative tolerability or acceptability of these different adverse effect profiles.
Strength and weaknesses:
This is the first meta-analysis to quantify the efficacy and safety of ketamine compared to ECT in patients with MDE. However, most studies included had relatively small sample sizes and lacked long-term follow-up assessments. The lack of long-term follow-up studies limits information provided about long term side effects, such as ketamine related cystitis. There were no studies directly comparing ECT with esketamine.
ECT is known to have robust efficacy and is considered the gold standard treatment for treatment resistant depression. On the other hand, an increasing number of studies have demonstrated that ketamine can have rapid and robust antidepressant effects in treatment resistant depression. When making treatment recommendations, C-L Psychiatrists will need to consider the relative benefits and risks of ECT as compared with ketamine.