Ketamine and electroconvulsive therapy for severe depression: A network meta-analysis of efficacy and safety.
Journal of psychiatric research – July 01, 2024
Source: PubMed
Summary
Groundbreaking treatments offer new hope for those battling severe depression. A comprehensive network meta-analysis reveals that both electroconvulsive therapy and ketamine significantly improve symptoms, with ECT showing the strongest results. When comparing these treatments across multiple studies involving 1,370 patients, ECT emerged as the most effective option, followed by combined ECT-ketamine therapy, and ketamine alone.
Abstract
Ketamine, electroconvulsive therapy (ECT), and their combination are effective for treating severe depression, but few large-scale studies have compared these. We searched databases for randomized controlled trials (RCTs) using ketamine, ECT, ketamine + ECT, or placebo for severe depression. Standardized measures were efficacy outcomes. Risk of bias was assessed. Stata and ADDIS were used for network meta-analysis (NMA) comparing efficacy and adverse reactions post-treatment. This study was registered on PROSPERO (CRD42023476740). 17 RCTs with 1370 patients were included. NMA showed ECT and ketamine improved Hamilton Depression Rating Scale (HDRS) versus placebo; other comparisons not significant. Rank probabilities showed highest probability for ECT, followed by ketamine + ECT, ketamine, placebo. No differences in Montgomery-Asberg Depression Rating Scale (MADRS); highest rank probability again for ECT, followed by ketamine + ECT, ketamine, placebo. Analysis suggests ECT superior to ketamine and their combination for improving depressive severity, but individualized treatment selection warranted. Higher adverse reactions with ketamine + ECT need further study for optimized combined use.