Ketamine and electroconvulsive therapy for severe depression: A network meta-analysis of efficacy and safety.
Yecun Liu, Jiguo Yang, Yuanxiang Liu
Journal of psychiatric research July 1, 2024 DOI: 10.1016/j.jpsychires.2024.05.022 via PubMed
Summary
AI-generated from the abstractElectroconvulsive therapy (ECT) and ketamine each improve depressive symptoms more than placebo, but ECT appears superior to both ketamine and their combination for reducing depression severity. A network meta-analysis of 17 randomized controlled trials involving 1,370 patients with severe depression found that ECT had the highest probability of being the most effective treatment, followed by the combination of ketamine plus ECT, then ketamine alone, and finally placebo. No significant differences were observed on the Montgomery-Asberg Depression Rating Scale, though rank probabilities again favored ECT. The combination of ketamine and ECT was associated with more adverse reactions, indicating a need for further research on optimal combined use. Individualized treatment decisions remain important.
Study at a glance
| Characteristics | Systematic review and network meta-analysis Randomized Peer reviewed |
|---|---|
| Sample size | 1,370 |
| Population | Patients with severe depression |
| Interventions | Ketamine Electroconvulsive therapy |
| Topics | Ketamine |
| Keywords | Electroconvulsive therapy Network meta-analysis Severe depression Depression treatment |
| Citations | 8 |
| Key finding | Electroconvulsive therapy is superior to ketamine and their combination for improving depressive severity, though individualized treatment selection is warranted. |
Abstract
Ketamine, electroconvulsive therapy (ECT), and their combination are effective for treating severe depression, but few large-scale studies have compared these. We searched databases for randomized controlled trials (RCTs) using ketamine, ECT, ketamine + ECT, or placebo for severe depression. Standardized measures were efficacy outcomes. Risk of bias was assessed. Stata and ADDIS were used for network meta-analysis (NMA) comparing efficacy and adverse reactions post-treatment. This study was registered on PROSPERO (CRD42023476740). 17 RCTs with 1370 patients were included. NMA showed ECT and ketamine improved Hamilton Depression Rating Scale (HDRS) versus placebo; other comparisons not significant. Rank probabilities showed highest probability for ECT, followed by ketamine + ECT, ketamine, placebo. No differences in Montgomery-Asberg Depression Rating Scale (MADRS); highest rank probability again for ECT, followed by ketamine + ECT, ketamine, placebo. Analysis suggests ECT superior to ketamine and their combination for improving depressive severity, but individualized treatment selection warranted. Higher adverse reactions with ketamine + ECT need further study for optimized combined use.