Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (all authors); Interventional Psychiatry Services, Yale Psychiatry Hospital, New Haven, Connecticut (Katz, Ostroff, Ansari, Holmes, Sanacora).
2 papers in the library · 3 citations · publishing 2025-2026
For severe treatment-resistant depression, both electroconvulsive therapy (ECT) and ketamine are effective, but it remains unclear which is superior. Two noninferiority trials and three meta-analyses show efficacy for both treatments yet report contradictory findings about which works better. Discrepancies may stem from differences in patient selection, outcome measures, treatment delivery, and site experience. Each treatment has unique risks and benefits that should be weighed for individual patients. The authors aim to help clinicians choose the optimal treatment by evaluating the latest evidence and patient-specific factors.
Placebo effects in depression treatment trials are substantial and can obscure the true efficacy of new drugs, especially for psychedelic-like compounds. Expectancy, the therapeutic setting, and trial design all interact to shape patient outcomes. This review examines these factors and discusses emerging methods to mitigate, measure, or harness placebo effects in future research on rapid-acting antidepressants and psychedelic therapies.