Review on the Comparative Effectiveness of Ketamine and Electroconvulsive Therapy in Treatment-Resistant Depression
Maryam Qayyum, Saud Khan, Abdul Shakoor, Shoaib Hameed, Sajid Usman Shah, Jannat Nazir
Pakistan Journal of Medicine and Dentistry September 29, 2025 DOI: 10.36283/ziun-pjmd14-4/101
Summary
AI-generated from the abstractTreatment-resistant depression (TRD) affects 20–30% of people with major depressive disorder and is hard to treat. Ketamine and electroconvulsive therapy (ECT) are two promising nontraditional interventions. They differ in how they work, how fast they act, how long benefits last, and their safety. This review compares their clinical effectiveness, response and remission rates, and side effects, and discusses patient selection, treatment protocols, and practical considerations. The authors emphasize tailoring treatment to each patient to improve outcomes.
Study at a glance
| Characteristics | Review Peer reviewed |
|---|---|
| Key finding | Ketamine and ECT both show meaningful antidepressant effects for TRD but differ in mechanisms, onset, durability, and safety profiles. |
Abstract
Treatment-resistant depression (TRD) affected nearly 20–30% of individuals diagnosed with major depressive disorder and remained a significant therapeutic challenge. The lack of response to traditional antidepressant therapies placed a substantial emotional, functional, and economic burden on patients and healthcare systems. In recent years, ketamine and electroconvulsive therapy (ECT) emerged as two of the most promising nontraditional interventions for individuals with TRD. Although both treatments demonstrated meaningful antidepressant effects, important differences were observed in their mechanisms, onset of action, durability of response, and safety profiles. This review aimed to provide a comprehensive comparative overview of ketamine and ECT in the management of TRD, summarizing evidence regarding their clinical efficacy, response and remission rates, and adverse effect profiles. The review also highlighted key clinical considerations, including patient selection criteria, treatment protocols, and practical issues that influenced therapeutic decision-making. By integrating findings from contemporary clinical studies and expert perspectives, this article offered clinicians an informative synthesis to support individualized treatment planning. Ultimately, the review underscored the importance of tailoring interventions to patient needs and contributed insights to improve outcomes for individuals affected by the burden of treatment-resistant depression.