1. In this systematic review and meta-analysis, electroconvulsive therapy (ECT) resulted in fewer depression symptoms compared to ketamine.

2. However, in studies that assessed cognition/memory or serious adverse events, there were no significant differences between ECT and ketamine.

Evidence Rating Level: 1 (Excellent)

Electroconvulsive therapy (ECT) is the gold standard for treating treatment-resistant major depression (TRD). However, ECT has been underused due to various professional and patient-related barriers. As an alternative, intravenously delivered ketamine has shown promise to effectively treat TRD. Currently, no study has quantified and compared the effect size, safety, and efficacy between ECT and ketamine. As a result, the objective of the present systematic review and meta-analysis was to compare these two therapies in patients with major depressive disorder.

Of 1248 screened articles, 6 trials (n=340 patients; 162 for ECT, 178 for ketamine) from database inception to April 2022 were included. Studies were included if they evaluated the effects of ECT or ketamine on depressive symptoms in patients meeting diagnostic criteria for major depressive disorder. Studies were excluded if they used non-human participants and if they did not use standardized measures of depression. Risk of bias and study quality were evaluated using the Cochrane Collaboration Risk of Bias tool. Improvement in depressive symptoms was calculated using Hedges g standardized mean differences (SMDs) and fixed or random-effects models. The review was in accordance with PRISMA guidelines. The primary outcome was improvement of depression symptoms and severity.

Results demonstrated that ECT was superior to ketamine across various depressive symptoms measured. However, 3 studies showed that ketamine had faster antidepressant effects than ECT. Furthermore, the side effect burden differed between both treatments: ketamine had a lower risk of certain adverse events such as headache and muscle pain while ECT had lower risks of blurred vision, vertigo, diplopia, etc. However, the study was limited by the inclusion of studies with small sample sizes which may have led to them being underpowered. Nonetheless, the results of this review highlight the potential superiority of ECT to ketamine in improving depressive symptoms.

Click to read the study in JAMA Psychiatry

Image: PD

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