New England Journal of Medicine
May 24, 2023
A. Anand, S. Mathew, G. Sanacora et al.
263 citations
For treatment-resistant major depression without psychosis, intravenous ketamine is at least as effective as electroconvulsive therapy (ECT). In a randomized trial with 403 patients, 55.4% of those receiving ketamine and 41.2% of those receiving ECT showed a 50% or greater reduction in depression scores over three weeks. ECT was linked to a notable decline in memory recall after three weeks (average decrease of 9.7 points on a memory test vs. 0.9 points with ketamine), with gradual recovery during follow-up. Quality-of-life improvements were similar between groups. Ketamine caused dissociation, while ECT led to musculoskeletal side effects.
Contemporary Clinical Trials
February 1, 2019
S. Mathew, S. Wilkinson, Murat Altinay et al.
54 citations
Electroconvulsive therapy (ECT) and ketamine show similar response rates for treatment-resistant depression, but a head-to-head comparison in a large, well-powered trial has been lacking. This protocol describes a non-inferiority trial randomizing 400 patients with treatment-resistant depression to receive either ECT thrice weekly or intravenous ketamine twice weekly for 3-5 weeks. The primary outcome is the proportion of responders based on a patient-reported depression scale. The study is designed to determine whether ketamine retains at least 90% of ECT's treatment effect. Results will inform patient choice, clinical practice, and insurance policies.
JAMA network open
June 3, 2024
Manish Kumar Jha, Samuel T Wilkinson, Kamini Krishnan et al.
29 citations
In people with treatment-resistant depression who do not have psychosis, intravenous ketamine works as well as electroconvulsive therapy (ECT) overall. Among outpatients with moderately severe or severe depression, ketamine produced greater improvement in depressive symptoms than ECT. In contrast, inpatients with very severe depression improved more with ECT early in treatment, though by the end of the three-week course both treatments were similarly effective. Higher premorbid intelligence and a diagnosis of posttraumatic stress disorder were linked to greater improvement with ECT, but not with ketamine. These findings may help patients and clinicians decide between the two treatments.
Journal of affective disorders
January 1, 2020
Roman M Dale, Kelly A Bryant, Nora Finnegan et al.
17 citations
In people with treatment-resistant depression who had previously failed electroconvulsive therapy, higher openness to experience—a personality trait reflecting curiosity and willingness to try new things—was the only factor among the Big Five personality domains that significantly predicted a sustained response to repeated intravenous ketamine infusions. The study of 125 participants confirmed that, regardless of treatment response, the group as a whole showed elevated neuroticism, low conscientiousness, and low extraversion. The authors suggest that assessing openness could help identify patients most likely to benefit from long-term ketamine therapy and reduce unnecessary exposure to its unknown risks, though they note limitations including the lack of a placebo control, small sample, and non-standardized infusion schedules.
Psychedelic medicine (New Rochelle, N.Y.)
June 1, 2025
Rahul Katkar, Ashley M Perez, Murat Altinay et al.
4 citations
LSD experiences focused on gender identity have been reported informally but not studied systematically. Analyzing 94 anecdotes from the Reddit subreddit r/LSD, nearly half of authors identified as non-cisgender at the time of use, and most of those reported enhanced self-acceptance regarding their gender identity. Among authors who were questioning their gender, most reported clarifying effects from LSD. A minority of cisgender authors explored non-cisgender identities during their experience, and some reported that the experience introduced a persistent non-cisgender identity for the first time. Challenging experiences were reported by 17% of authors, and 11% of non-cisgender authors reported decreased self-acceptance. The findings suggest LSD may support gender identity exploration and acceptance, but the fragmentary nature of social media data requires confirmation through surveys and prospective studies.
American journal of medical genetics. Part B, Neuropsychiatric genetics : the official publication of the International Society of Psychiatric Genetics
June 17, 2025
Clio E Franklin, Murat Altinay, Kala Bailey et al.
2 citations
For treatment-resistant mood disorders, intensive interventions such as electroconvulsive therapy, transcranial magnetic stimulation, ketamine, and esketamine are commonly used, but how genetics influences response to these therapies remains unclear. A review of the current literature finds that most studies have examined single variants in candidate genes, particularly COMT and BDNF, yet none have been consistently reproducible. Genome-wide association studies are few and mostly underpowered, with only one exceeding 1000 participants, yielding few statistically significant single nucleotide polymorphisms outside COMT and BDNF. Large-scale data collection is needed to establish genetic predictors and differentiate responses among treatments, a goal being pursued by the worldwide Gen-ECT-ic consortium.
Psychedelic Medicine
December 30, 2025
Brian S. Barnett, Akhil Anand, Tatiana Falcone et al.
Between 2015 and 2019, past-year LSD use rose 43% among heterosexual individuals, 58% among bisexual individuals, and 106% among lesbian/gay individuals in the United States. Lesbian, gay, and bisexual (LGB) people were 3.3 to 4.4 times more likely to report past-year LSD use than heterosexual people, depending on the year. Living in poverty, being divorced versus married, living in a small metropolitan area versus a non-metropolitan area, and a past-year suicide attempt were unique correlates of LSD use for heterosexual individuals compared with LGB individuals. The findings suggest a need for targeted harm reduction strategies based on sexual identity.
Psychiatric Annals
February 1, 2020
Hatice Guncu Kurt, Murat Altinay, Amit Anand
Patients unresponsive to two antidepressant trials are considered to have treatment-resistant depression (TRD). A review of open-label studies found that various pharmacological and brain stimulation treatments produce similar response rates of 30% to 70% and remission rates of 20% to 50%. In randomized placebo-controlled trials, response rates ranged from 15% to 60% and remission rates from 10% to 40%. Ketamine and electroconvulsive therapy achieve rates at the higher ends of these ranges, with the advantage of rapid action in acute settings. Direct comparative studies with large samples are needed to determine if one treatment offers greater benefit.