Is ketamine an appropriate alternative to ECT for patients with treatment resistant depression? A systematic review
This review (s=6, 2020) compares ketamine with ECT as treatments for treatment-resistant depression (TRD). The authors preliminarily conclude that ketamine may show effects faster, but these effects seem to be less durable.
Authors
- Robert Schoevers
- Jeanine Kamphuis
- Jolien Veraart
Published
Abstract
Objective
Ketamine has repeatedly shown to have rapid and robust antidepressant effects in patients with treatment resistant depression (TRD). An important question is whether ketamine is as effective and safe as the current gold standard electroconvulsive therapy (ECT).
Methods
The literature was searched for trials comparing ketamine treatment with ECT for depression in the Pubmed/MEDLINE database and Cochrane Trials Library.
Results
A total of 137 manuscripts were identified, 6 articles were included in this review. Overall quality of the included studies was diverse with relevant risk of bias for some of the studies. Results suggest that ketamine treatment might give faster but perhaps less durable antidepressant effects. Side effects differed from ECT, in particular less cognitive impairment was apparent in ketamine treatment.
Limitations
The included studies have limited sample sizes, use different treatment protocols and in most trials, longer term follow up is lacking. Furthermore, allocation bias appears likely in the non-randomized trials.
Conclusions
Current available literature does not yet provide convincing evidence to consider ketamine as an equally effective treatment alternative to ECT in patients with TRD. There are indications for a more favourable short term cognitive side effect profile after ketamine treatment. Methodologically well-designed studies with larger sample sizes and longer follow up duration are warranted.
Research Summary of 'Is ketamine an appropriate alternative to ECT for patients with treatment resistant depression? A systematic review'
Introduction
Major depressive disorder is common and a substantial contributor to global disability. A sizeable minority of patients—more than 30% according to the introduction—do not achieve remission after multiple antidepressant trials and are classified as having treatment resistant depression (TRD). Electroconvulsive therapy (ECT) is regarded in guidelines as the gold-standard intervention for TRD because of its high efficacy, but it has disadvantages: repeated general anaesthesia, variable availability, public stigma, and a risk of cognitive adverse effects that many patients find distressing. Relapse after an initial ECT course is also common, so alternatives that match ECT’s efficacy but have more acceptable side-effect profiles and improved relapse prevention are clinically desirable. Veraart and colleagues frame ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, as a candidate alternative because of consistent evidence for rapid antidepressant effects in major depression, including in severe TRD, and generally transient acute side effects. The review aims to identify and summarise studies that directly compare ketamine treatment with ECT in patients with depression, to address whether ketamine could be an effective and acceptable alternative to ECT and inform where ketamine might sit within stepped treatment algorithms.
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Study Details
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- APA Citation
Veraart, J. K., Smith-Apeldoorn, S. Y., Spaans, H., Kamphuis, J., & Schoevers, R. A. (2021). Is ketamine an appropriate alternative to ECT for patients with treatment resistant depression? A systematic review. Journal of Affective Disorders, 281, 82-89. https://doi.org/10.1016/j.jad.2020.11.123
References (4)
Papers cited by this study that are also in Blossom
Basso, L., Bönke, L., Aust, S. et al. · Journal of Psychiatric Research (2020)
Han, Y., Chen, J., Zou, D. et al. · Neuropsychiatric Disease And Treatment (2016)
Kishimoto, T., Chawla, J. M., Hagi, K. et al. · Psychological Medicine (2016)
Short, B., Fong, J., Galvez, V. et al. · Lancet Psychiatry (2017)
Cited By (3)
Papers in Blossom that reference this study
Van Elk, M., Fried, E. I. · Therapeutic Advances in Psychopharmacology (2023)
Rhee, T. G., Shim, S. R., Forester, B. P. et al. · JAMA Psychiatry (2022)
Hassan, K., Struthers, W. M., Sankarabhotla, A. et al. · Frontiers in Psychiatry (2022)
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