Efficacy and adverse effects of ketamine versus electroconvulsive therapy for major depressive disorder: A systematic review and meta-analysis
Debora de A. Simoes Moreira, Luís Eduardo Gauer, Guilherme Teixeira, A. D. da Silva, Stefanie Cavalcanti, J. Quevedo
Journal of Affective Disorders March 1, 2023 DOI: 10.1016/j.jad.2023.02.152 via Semantic Scholar
Summary
A systematic review and meta-analysis of eight randomized controlled trials or cohort studies comparing ketamine with electroconvulsive therapy (ECT) for treatment-resistant depression found no evidence that ketamine is superior to ECT in reducing depressive symptom severity or in achieving response to therapy. Among side effects, patients treated with ketamine had a statistically significant lower risk of muscle pain compared with those receiving ECT. The analysis also noted trends toward more dissociative symptoms with ketamine and less nausea and headache, but these differences were not statistically significant. The authors caution that the small number of eligible studies, high heterogeneity, and risk of bias limit the strength of these conclusions.
Study at a glance
| Characteristics | Systematic review and meta-analysis Randomized Peer reviewed |
|---|---|
| Population | Patients with treatment-resistant depression (TRD) |
| Keywords | Medicine |
| Citations | 25 |
| Key finding | Ketamine was not superior to ECT for reducing depressive symptoms or response rate, but was associated with a significantly lower risk of muscle pain. |
Abstract
Background: ECT is considered the fastest and most effective treatment for TRD. Ketamine seems to be an attractive alternative due to its rapid-onset antidepressant effects and impact on suicidal thoughts. This study aimed to compare efficacy and tolerability of ECT and ketamine for different depression outcomes (PROSPERO/CRD42022349220). Methods: We searched MEDLINE, Web of Science, Embase, PsycINFO, Google Scholar, Cochrane Library and trial registries, which were the ClinicalTrials.gov and the World Health Organization’s International Clinical Trials Registry Platform, without restrictions on publication date. Selection criteria: randomized controlled trials or cohorts comparing ketamine versus ECT in patients with TRD. Results: Eight studies met the inclusion criteria (of 2875 retrieved). Random-effects models comparing ketamine and ECT regarding the following outcomes were conducted: a) reduction of depressive symptoms severity through scales, g = −0.12, p = 0.68; b) response to therapy, RR = 0.89, p = 0.51; c) reported side-effects: dissociative symptoms, RR = 5.41, p = 0.06; nausea, RR = 0.73, p = 0.47; muscle pain, RR = 0.25, p = 0.02 and headache, RR = 0.39, p = 0.08. Influential & subgroup analyses were performed. Limitations: Methodological issues with high risk of bias in some of the source material, reduced number of eligible studies with high in-between heterogeneity and small sample sizes. Conclusion: Our study showed no evidence to support the superiority of ketamine over ECT for severity of depressive symptoms and response to therapy. Regarding side effects, there was a statistically significant decreased risk of muscle pain in patients treated with ketamine compared to ECT.