A systematic review and meta-analysis of six clinical trials involving 340 patients with major depressive episodes found that electroconvulsive therapy (ECT) was more effective than ketamine for reducing depression severity in the acute phase, with a standardized mean difference of -0.69 favoring ECT. No significant differences were observed between the two treatments for cognition, memory, or serious adverse events. Ketamine carried lower risks of headache and muscle pain, while ECT carried lower risks of blurred vision, vertigo, diplopia, and dissociative symptoms. The findings suggest ECT may be superior, but treatment decisions should be individualized.
Treatment-resistant depression (TRD) often requires rapid symptom relief. Intravenous ketamine (KET-IV) and intranasal esketamine (ESK-NS) are glutamatergic agents that show rapid antidepressant effects, with KET-IV acting faster and ESK-NS providing long-term maintenance. The authors propose a "ketamine/esketamine bridge therapy" for further testing, modeled on a strategy from internal medicine: KET-IV would induce rapid effects, then patients would transition to ESK-NS for sustained benefit. This approach aims to address the limited accessibility of intravenous ketamine and leverage the scalability of the intranasal formulation, potentially benefiting patients with acute depression or suicidal ideation.