Outcomes of patients receiving interventional psychiatric procedures in a large integrated healthcare system.
Kevin J Li, Natalie E Slama, Ingrid L Chen, Samuel Ridout, Esti Iturralde
Psychiatry research July 19, 2025 DOI: 10.1016/j.psychres.2025.116647
Summary
Many with severe depression find significant relief beyond standard medication. A large integrated healthcare system analyzed thousands of major depressive disorder (MDD) patients, including those with treatment resistant depression (TRD). They compared Electroconvulsive therapy (ECT), Transcranial Magnetic Stimulation (TMS), and IV ketamine infusions (including Esketamine) against traditional medication. These interventional procedures significantly improved depression within six weeks. Crucially, continued ketamine treatment was linked to a 75% lower 12-month psychiatric hospitalization risk. This highlights their effectiveness, even for bipolar disorder.
Abstract
Interventional psychiatric procedures (IPPs) such as electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and ketamine intravenous treatments (KIT) are widely used for treatment resistant depression (TRD), but we lack studies of their real-world impact compared to standard outpatient medication management (MM). Longitudinal electronic health records of 22,481 patients in a large integrated healthcare system during 2018-2022 were examined to describe depression improvement via 9-item Patient Health Questionnaire (PHQ-9), changes in psychiatric admissions, and use of continuation/maintenance (C/M) treatments. Overall, each IPP group had significantly greater depression improvement at 6 weeks compared to MM: adjusted estimates TMS:1.64 (p < 0.001), KIT:2.02 (p < 0.001), and ECT:2.16 (p < 0.001). Patient characteristics were associated with symptom worsening within treatment groups, for example: (1) non-white race for ECT (2.33, p < 0.01) and MM (0.29, p < 0.001); (2) anxiety disorder for TMS (1.73, p < 0.001); and (3) personality disorder for all treatment groups, with significant coefficients found for KIT (3.27, p < 0.05) and MM (1.27, p < 0.001). Some examples of correlations with improved symptom response include: (1) psychotic disorder for ECT (-3.57, p < 0.01); and (2) bipolar disorder for KIT (-2.19; p < 0.05). For the KIT group, C/M treatment versus no C/M treatment was associated with lower risk for 12-month psychiatric hospitalization (adjusted relative risk: 0.25). This is the first study to show a protective association for maintenance ketamine on psychiatric hospitalization risk. Treatment-specific predictors of response should be confirmed in future comparative effectiveness studies.