More successful than ketamine – a shocking treatment for depression
Electroshock therapy, which has been portrayed unfavorably in movies and TV shows, consistently produces better results for treatment-resistant depression.
According to an analysis of six studies that recently published their findings in JAMA Psychiatryelectroconvulsive therapy (ECT) is better than ketamine in the rapid relief of severe depression.
According to the World Health Organization, depression is a widespread condition that affects approximately 5% of individuals worldwide (WHO). Feeling sad, irritable, losing pleasure in previously wonderful things, and even suffering from unexplained pain or fatigue for weeks on end are all signs of depression. The most common first choice for treating depression is the use of oral antidepressants (along with psychotherapy). However, if oral antidepressants are ineffective or if the patient is at imminent risk of self-harm, there are other, more rapid treatment options, including ECT and, more recently, ketamine or esketamine.
Ketamine is used less frequently in the US than esketamine, a nasal spray approved by the Food and Drug Administration to treat depression. However, there are no studies comparing the effectiveness of ECT with esketamine. Ketamine, a sister drug to esketamine, has been studied. Ketamine is commonly used as an injectable anesthetic in medicine, but has recently been explored as a fast-acting intervention to help those suffering from severe depression.
T. Greg Rhee, a psychiatric epidemiologist at University of Connecticut Faculty of Medicine, and colleagues from Harvard UniversityKyungnam University in Korea, McLean Hospital and Massachusetts General Hospital in Boston, University of TorontoVA New England Mental Illness in West Haven, and Yale University examined six global clinical trial studies contrasting ketamine with ECT for major depression. A total of 340 patients participated in the trials, which were conducted in hospitals in Sweden, Germany, Iran and India.
All six studies independently found ECT to be more effective than ketamine in alleviating severe depressive symptoms.
“ECT is consistently more successful than ketamine” in helping patients with severe depression, Rhee says. “We found no differences according to age, gender or geographic location. So we can say that everyone who is eligible for ECT will benefit.”
Although ketamine generally helped patients, ECT generally had better results. Ketamine may be a viable treatment for people who cannot undergo ECT. The side effect profiles of the two treatments differed, with ECT more likely to cause headaches, muscle pain and memory loss, while ketamine was more likely to cause dissociative symptoms, dizziness and double vision.
Two additional studies comparing ECT and ketamine are underway, and Rhee hopes to add their data to the analysis as they become available.
“Every single study directly reports that ECT works better than ketamine. But people are still skeptical of ECT, maybe because of the stigma,” says Rhee, or negative portrayals in movies like “One Flew Over the Cuckoo’s Nest” and shows like “Stranger Things.” “We need to improve public awareness of ECT for treatment-resistant depression.”
Reference: “Efficacy and Safety of Ketamine Versus Electroconvulsive Therapy Among Patients with a Major Depressive Episode: A Systematic Review and Meta-Analysis” Taeho Greg Rhee, Ph.D., Sung Ryul Shim, Ph.D., Brent P. Forester, MD , MSc, Andrew A. Nierenberg, MD, Roger S. McIntyre, MD, George I. Papakostas, MD, John H. Krystal, MD, Gerard Sanacora, MD, Ph.D. and Samuel T. Wilkinson, MD, on October 19, 2022. JAMA Psychiatry.