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.
Biological Psychiatry
May 6, 2011
Amy K. Ricke, R. Snook, A. Anand
34 citations
A 42-year-old woman with chronic pain from reflex sympathetic dystrophy, who was high-functioning despite high-dose opioid use, underwent experimental IV ketamine therapy. Her antidepressant and sleep medications were initially held. She reported immediate pain relief, but pain returned by day 2. After restarting two of her medications on day 3, she reported significant relief by day 4. Starting on day 7, she exhibited over-sedation, admitted to self-administering opioids from a hidden supply, and became irritable and emotionally labile. She detailed past traumas without prompting. Despite restarting quetiapine and increasing duloxetine, her symptoms worsened, including pressured speech and tangential, disorganized communication. The case suggests ketamine therapy may unmask or trigger mania-like symptoms in vulnerable individuals.