Electroconvulsive Therapy Versus Ketamine for Major Depressive Episode
BJPsych Open June 1, 2026 James Finlay
A review of studies comparing electroconvulsive therapy (ECT) and ketamine for major depression finds that ECT is more effective at reducing depressive symptoms, as measured by standard rating scales. Evidence on suicidal thoughts is limited, with no clear difference between the two treatments in the short term. Cognitive effects are mixed; ketamine may offer better short-term cognitive performance, but some studies find no difference. Side effects differ: ECT commonly causes headaches and muscle pain, while ketamine is linked to temporary dissociative and perceptual symptoms. Cost-effectiveness favors ECT, which produces more quality-adjusted life years at lower cost. Ketamine may still be useful for patients who need rapid relief or who have not responded to ECT.