More successful than ketamine: a shocking treatment for depression

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Electroconvulsive therapy is a psychiatric treatment that involves electrically inducing a generalized seizure to treat mental disorders.

Depicted unfavorably in movies and television shows, electroshock therapy consistently produces better results for depression that is resistant to treatment.

According to an analysis of six studies that recently published their findings in JAMA Psychiatryelectroconvulsive therapy (ECT) is better than ketamine for rapid relief of major depression.

According to the World Health Organization, depression is a widespread condition that affects approximately 5% of people worldwide (WHO). Feeling sad, irritable, losing pleasure in things that were once enjoyable, and even enduring unexplained pain or fatigue for weeks are all signs of depression. The most common first-line treatment for depression is the use of an oral antidepressant (along with psychotherapy). However, if oral antidepressants are ineffective or if the patient is in immediate danger of self-harm, other more rapid therapy options exist, such as ECT and, more recently, ketamine or esketamine.

Ketamine is used less commonly in the US than esketamine, a nasal spray that has been 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 typically used as an injectable anesthetic in medicine, but has recently been investigated as a fast-acting intervention to help those with severe depression.

T. Greg Rhee, a psychiatric epidemiologist at the University of Connecticut School of Medicine, and associates at Harvard University, Kyungnam University in Korea, McLean Hospital and Massachusetts General Hospital in Boston, the University of Toronto, VA New England Mental Illness in West Haven, and Yale University reviewed six studies from global clinical trials that contrasted ketamine with ECT for major depression. The trials, which took place at hospitals in Sweden, Germany, Iran and India, involved 340 patients in total.

All six studies independently found that ECT was more effective than ketamine in alleviating symptoms of severe depression.

“ECT is consistently more successful than ketamine” in helping patients with severe depression, Rhee says. “We did not find differences by age, sex or geographic location. So we could say that anyone who is eligible for ECT will benefit.”

Although ketamine generally helped patients, ECT had better results overall. Ketamine could be a viable treatment for people who cannot undergo ECT. The side effect profiles of the two treatments differed, with ECT being more likely to cause headaches, muscle pain, and memory loss, while ketamine was more likely to cause dissociative symptoms, vertigo, and double vision.

There are two additional studies comparing ECT and ketamine underway, and Rhee hopes to add their data to the analysis when they become available.

“Each study directly reports that ECT works better than ketamine. But people are still skeptical of ECT, perhaps because of the stigma,” Rhee says, or because of the 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 Major Depressive Episode: Systematic Review and Meta-Analysis” by 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, Oct. 19, 2022, JAMA Psychiatry.
DOI: 10.1001/jamapsychiatry.2022.3352

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