Major Depressive Disorder (MDD)Depressive DisordersSafety & Risk ManagementKetamine

Ketamine vs Electroconvulsive Therapy for Major Depressive Episode: A Systematic Review and Meta-analysis

This systematic review & meta-analysis of five RCTs (ketamine: n=141; ECT: n=137) compared the efficacy & safety of ketamine and electroconvulsive therapy (ECT) in adults with major depressive episodes. The results suggested that ECT was superior to ketamine in post-treatment depression ratings, response rates, and remission rates one week after treatment. However, there was no significant difference between the groups in the number of sessions to response and remission or cognitive outcomes.

Authors

  • Menon, V.
  • Varadharajan, N.
  • Faheem, A.

Published

JAMA Psychiatry
meta Study

Abstract

Importance

The relative efficacy of ketamine and electroconvulsive therapy (ECT) in adults with major depressive episode (MDE) needs clarification.

Objective

To compare depression rating outcomes with ketamine vs ECT in adults with MDE and to compare response and remission rates, number of sessions to response and remission, and adverse effects.

Data Sources

Two investigators independently systematically searched MEDLINE, ScienceDirect, and Google Scholar databases using a combination of relevant Medical Subject Headings terms and free-text keywords from database inception through May 15, 2022, to identify relevant English-language trials.

Study Selection

Parallel-group randomized clinical trials (RCTs). Data Extraction and Synthesis Two investigators independently extracted data and assessed risk of bias. One-week posttreatment outcomes were pooled as standardized mean difference (SMD; Hedges g) for continuous outcomes and risk ratio (RR) for categorical outcomes in random-effects meta-analyses.

Main Outcomes and Measures

Efficacy outcomes were 1-week (or nearest) posttreatment depression ratings, 1-week (or nearest) study-defined response and remission rates, and number of sessions to treatment response and remission. Safety outcomes were reported adverse effects.

Results

Five trials (ketamine group: n = 141; ECT group: n = 137) were meta-analyzed. The overall pooled SMD for posttreatment depression ratings was −0.39 (95% CI, −0.81 to 0.02; I2 = 45%; 5 RCTs). For this efficacy outcome, in a sensitivity analysis of methodologically stronger trials, ECT was superior to ketamine (SMD, −0.45; 95% CI, −0.75 to −0.14; I2 = 6%; 2 RCTs). ECT was also superior to ketamine for study-defined response (RR, 1.27; 95% CI, 1.06-1.53; I2 = 0%; 3 RCTs) and remission (RR, 1.43; 95% CI, 1.12-1.82; I2 = 0%; 2 RCTs) rates. No significant differences were noted between groups for number of sessions to response and remission and for cognitive outcomes. Key limitations were small number of studies, limited sample size, and high risk of bias in all trials.

Conclusion and Relevance

The findings of this systematic review and meta-analysis suggest an efficacy advantage for ECT over ketamine in adults with MDE. These conclusions are tempered by the small number and size of existing trials.

Available with Blossom Pro

Research Summary of 'Ketamine vs Electroconvulsive Therapy for Major Depressive Episode: A Systematic Review and Meta-analysis'

Introduction

Electroconvulsive therapy (ECT) is regarded as a criterion-standard antidepressant for major depressive episode (MDE) but its use is constrained by stigma, cognitive adverse effects, and uneven availability. Ketamine, an N‑methyl‑D‑aspartate (NMDA) receptor antagonist, has emerged as a rapidly acting antidepressant with a different adverse‑effect profile, and several randomised clinical trials (RCTs) have directly compared ketamine and ECT in adults with MDE. A prior meta-analysis concluded that ECT was superior to ketamine for antidepressant effect but found no clear differences in cognitive or serious adverse events; the present study seeks to update and extend that quantitative synthesis. Menon and colleagues conducted a systematic review and meta-analysis to compare ketamine and ECT in patients with MDE. Beyond post‑treatment depression ratings, the investigators aimed to synthesise trial-defined response and remission rates, the number of treatment sessions required to achieve response or remission, and adverse events, thereby informing clinical and research decision‑making about the relative roles of ketamine and ECT.

Expert Research Summaries

Go Pro to access AI-powered section-by-section summaries, editorial takes, and the full research toolkit.

See Pro PlansAlready have an account? Sign in

Study Details

References (3)

Papers cited by this study that are also in Blossom

Efficacy and Safety of Ketamine vs Electroconvulsive Therapy Among Patients With Major Depressive Episode: A Systematic Review and Meta-analysis

Rhee, T. G., Shim, S. R., Forester, B. P. et al. · JAMA Psychiatry (2022)

Comparison of Rapid Antidepressant and Antisuicidal Effects of Intramuscular Ketamine, Oral Ketamine, and Electroconvulsive Therapy in Patients With Major Depressive Disorder

Kheirabadi, D., Kheirabadi, G. R., Mirlohi, Z. et al. · Journal of Clinical Psychopharmacology (2020)

42 cited
Insights for the Use of Ketamine From Randomized Controlled Trials That Compared Ketamine With Electroconvulsive Therapy in Severe Depression

Andrade, C. · Journal of Clinical Psychiatry (2022)

Your Personal Research Library

Go Pro to save papers, add notes, rate studies, and organize your research into custom shelves.

See Pro PlansSign in
Ketamine vs Electroconvulsive Therapy for Major... — Research Summary & Context | Blossom