KET or ECT for treatment-resistant depression?
International journal of psychiatry in clinical practice – January 01, 2024
Source: PubMed
Summary
For patients battling treatment-resistant depression, two powerful options show remarkable promise. Ketamine and electroconvulsive therapy both demonstrate high success rates, with neither showing clear inferiority. While ketamine offers rapid response through IV administration, electroconvulsive therapy provides sustained relief through controlled sessions. Patient preferences and individual factors guide treatment choice, with each option having unique benefits and considerations.
Abstract
Modern electroconvulsive therapy (ECT) and ketamine currently represent the most effective treatment options in depressed patients showing non-response to two or more trials of antidepressants. Recently, large sample head-to-head comparisons of intravenous ketamine versus ECT for treatment-resistant depression (TRD) have fuelled the debate on which therapy might be more effective. However, the informative value of these studies is limited due to major methodological differences, especially regarding patients' baseline clinical characteristics and treatment procedures. This commentary, in reaction to the recently published article by Jha et al. 'Ketamine vs Electroconvulsive Therapy for Treatment-Resistant Depression: A Secondary Analysis of a Randomized Clinical Trial' in JAMA Network Open, addresses this issue and proposes that treatment decisions of ECT or ketamine should be based on substantiated, predictive clinical response markers and patient's preferences. It is undisputed that both treatments are highly effective in TRD, yet, given that ketamine is usually administered before ECT, efficacy studies of ECT in ketamine non-responders are urgently warranted.KEYPOINTSModern electroconvulsive therapy (ECT) and ketamine currently represent the most effective treatment options in treatment-resistant depressionHead-to-head comparisons of both treatments have yielded incongruent findings due to differing patients' baseline clinical characteristics and treatment proceduresTreatment-decisions of ECT or ketamine should be based on predictive clinical response markers and patient's preferences while considering the specific side effect profiles of both optionsFuture prospective studies should assess the efficacy of ECT in ketamine non-responders.