Ketamine or Electroconvulsive Therapy as Treatment Approach to Severe Depression: The Necessity of More Personalized Management
Ketamine January 1, 2025 Pouya Movahed Rad, Akihiro Takamiya
Electroconvulsive therapy (ECT) and racemic ketamine are both effective treatments for severe major depressive disorder, but they target different patient populations. Systematic reviews show higher remission rates with ECT than with ketamine. However, ketamine acts rapidly and causes less cognitive side effects, making it valuable for outpatients or when ECT is unavailable. ECT induces transient cognitive impairments, while ketamine commonly causes dissociative symptoms. Older patients and those with psychotic symptoms respond better to ECT, whereas younger patients with longer episode duration may benefit similarly from ketamine. Although biological variables and brain imaging hold promise as biomarkers, their clinical use remains limited. The review advocates integrating clinical predictors with patient characteristics to personalize treatment.