Comparative efficacy and safety of intravenous racemic ketamine, repetitive transcranial magnetic stimulation and electroconvulsive therapy for Stage 2 or higher treatment-resistant depression: A systematic review and network meta-analysis.
PCN reports : psychiatry and clinical neurosciences September 1, 2025 Itsuki Terao, Takahiro Tsuge, Tomoo Sato et al. 2 citations
A network meta-analysis of 35 randomized controlled trials involving 2109 participants compared electroconvulsive therapy (ECT), intravenous racemic ketamine, and repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant depression. No significant differences emerged in response rate, remission rate, or tolerability among the three treatments. Intravenous ketamine showed significantly higher acceptability than rTMS and ECT. The confidence in the evidence for efficacy, tolerability, and acceptability was very low, largely due to small-study bias. The authors suggest that both ketamine and rTMS may be viable alternatives to ECT, but caution that larger studies are needed to confirm these findings.