Is ketamine as effective as ECT for treatment-resistant depression?

New research this week is the latest to find that ketamine can help people with hard-to-treat depression. THE the study has found that people with treatment-resistant depression responded just as well to ketamine therapy as those who received electroconvulsive therapy, an intervention commonly used in these cases.

Ketamine has been used as an anesthetic in medicine for decades. It can also be used as a recreational drug with euphoric and dissociative effects. But more recently, it has been adopted as a new type of treatment for depression. The drug can be given off-label as an intravenous infusion, while a nasal spray version was approved for depression by the Food and Drug Administration in 2019.

One of the reasons scientists are excited about ketamine is that it seems to affect the brain in a way otherwise other antidepressants, and often much faster. This suggests that it is possible to one day develop a new class of better or safer drugs from his example. And that also means that ketamine might be able to help patients who haven’t responded to other interventions. Although ketamine may be effective for some patients with depression, it is not yet clear how often it should be used.

This new study, published Wednesday in the New England Journal of Medicine, is perhaps the largest of its kind to directly compare ketamine to one of these existing options: electroconvulsive therapy, or ECT. ECT got a bad rap at times, largely due to its early iterations being genuinely less secure. But it’s remained a pillar in psychiatry for decades and is often considered a gold standard intervention for treatment-resistant depression.

The study involved approximately 400 patients who sought care at one of five different clinics across the country for their treatment-resistant depression. They were randomized to receive standard ECT or intravenous ketamine infusions over a three-week period. Those who responded to either treatment, defined as a 50% or more improvement in their symptoms, were then followed up for another six months.

Ketamine met the primary endpoint of the trial, being noninferior to ECT, but he might even have surpassed the latter. Overall, 55.4% of patients in the ketamine group responded to treatment, compared with 41.2% of those in the ECT group. People in both groups also experienced a similar improvement in their quality of life.

Some previous research has suggested that ECT might be more effective in treating acute depression than ketamine. But the authors note that these studies tended to involve smaller sample sizes and may have involved patients less likely to benefit from ketamine. Due to the dissociative effects of ketamine, for example, it is not recommended for people with depression who have also suffered from psychosis, and the authors explicitly excluded such patients from the trial.

Ketamine and ECT carry their own unique risks. In this trial, for example, patients using ECT was more likely to have memory problems, a well-known complication. Conversely, some experts have expressed concern about the addictive potential of therapeutic ketamine if used regularly, although this study was unable to assess this risk.

In the end, these and other discoveries suggest that although ketamine is not a miracle cure for depression, it can be a valuable and even preferred alternative for people who do not respond to first-line antidepressants.

“It’s a question of assessing the risks for each patient,” said Boris Heifets, a ketamine researcher at Stanford University not involved in the study. said STAT News. “None of these things are risk-free or transformative.”

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