Electroconvulsive remedy (ECT) is simpler than intravenous (IV) ketamine for sufferers experiencing a significant depressive episode (MDE) in new findings which can be in keeping with the KetECT examine ― the primary head-to-head trial of ketamine and ECT.
As reported by Medscape Medical Information, the KetECT trial was revealed earlier this 12 months. It confirmed that ECT was simpler than IV ketamine for hospitalized sufferers with extreme despair. ECT yielded increased remission charges and a larger discount of signs.
Regardless of the obvious superiority of ECT over ketamine, the researchers of the present meta-analysis warning that remedy choices for MDE “ought to nonetheless be individualized and patient-centered as a result of ketamine’s quicker antidepressant results should be fascinating for sure sufferers with extreme MDE who require fast restoration from the severity of despair.”
The examine was revealed on-line October 19 in JAMA Psychiatry.
The evaluate included six medical trials with 340 sufferers with MDE. Of these sufferers, 162 have been handled with ECT, and 178 have been handled with ketamine. The imply age of the individuals ranged from 37 to 52 years.
The first efficacy final result of curiosity was enchancment of depressive signs.
ECT was superior to ketamine throughout totally different depressive symptom measures, report Taeho Greg Rhee, PhD, with the College of Connecticut Faculty of Drugs, in Farmington, and colleagues.
The standardized imply distinction (SMD) was -0.59 (95% CI, -0.85 to -0.33) on the Montgomery-Åsberg Despair Ranking Scale.
The SMD was -0.83 (95% CI, -1.22 to -0.44] on the Hamilton Despair Ranking Scale and -0.86 (95% CI, -1.50 to -0.22) on the Beck Despair Stock.
The general pooled SMD for ECT, when put next with ketamine, was -0.69 (95% CI, -0.89 to -0.48), indicating that ECT was extra efficacious than ketamine.
The researchers didn’t discover any moderating results of varied components, together with age, male intercourse, and presence of psychotic options.
For cognition and reminiscence efficiency, one examine reported that the ketamine group outperformed the ECT group in cognition, however the impact measurement was small to average.
A separate examine that reported reminiscence efficiency discovered no distinction between ketamine and ECT, although this examine was seemingly underpowered to detect such variations, with a complete pattern measurement of 32.
“Due to underpowered examine designs, no agency conclusions concerning cognition and reminiscence efficiency may be made on this meta-analysis. Future analysis ought to handle this concern,” the investigators write.
Distinctive Facet Results
Ketamine and ECT had distinctive hostile impact profiles.
With ketamine, there was a decrease threat of headache and muscle ache however the next threat of transient dissociative or depersonalization signs. With ECT, there was a decrease threat of blurred imaginative and prescient, vertigo, and diplopia/nystagmus.
Just one examine reported suicide makes an attempt and suicide deaths, for which there was no marked distinction between ECT and ketamine.
A limitation of the meta-analysis is the low to average methodologic high quality of the research that have been included, in addition to using totally different ketamine and/or ECT remedy protocols, which might have influenced efficacy and security outcomes.
The researchers observe that extra analysis is required to optimize long-term remedy outcomes for each ketamine and ECT to stop relapse, “which is of key significance for medical follow.”
The examine had no particular funding. Rhee at present serves as a co–editor-in-chief of Psychological Well being Science and can obtain honorarium funds yearly from the writer, John Wiley & Sons. An entire listing of the authors’ related monetary relationships is out there with the unique article.
JAMA Psychiatry. Printed on-line October 19, 2022. Summary
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