A systematic review of five randomized controlled trials involving 472 adults with major depressive disorder found that psilocybin improved depressive symptoms in three of the five studies and reduced anxiety symptoms in four of the five studies compared to controls. Suicidal ideation improved in only one trial. Discontinuation rates were similar between psilocybin (2–13%) and control groups (4–21%). The most common adverse drug reaction in both groups was headache. The authors conclude that psilocybin is effective for depressive and anxiety symptoms but note that long-term efficacy and safety require further investigation in larger trials.
A meta-analysis of four randomized controlled trials (239 participants) compared ketamine alone or ketamine plus propofol against propofol alone in patients with major depressive disorder receiving a single electroconvulsive therapy session. Ketamine alone and the combination showed greater improvement in depressive symptoms at days 1, 3, and 7 after treatment, and were associated with longer seizure duration and higher seizure energy index. Ketamine alone also increased eye-opening time. However, the overall quality of evidence was very low or low, indicating a need for higher-quality trials.
A meta-analysis of five randomized controlled trials involving 664 patients with major depressive disorder or bipolar depression found that intravenous (IV) ketamine produced a greater reduction in depressive symptoms 24 hours after the first treatment compared to electroconvulsive therapy (ECT). However, by the end of treatment, both approaches showed similar rates of response and remission. Neurocognitive outcomes were inconsistent across studies. IV ketamine caused more dissociation, blurred vision, dizziness, and double vision, while ECT led to more muscle pain. The faster onset of antidepressant effects with IV ketamine does not translate into superior long-term outcomes, and larger trials are needed to assess lasting efficacy and safety.
China's National Health Commission prioritizes early diagnosis and standardized treatment of major depressive disorder (MDD). Rapid treatment centers across the country use electroconvulsive therapy (ECT), intravenous ketamine/esketamine, esketamine nasal spray, magnetic seizure therapy (MST), and Stanford Neuromodulation Therapy (SNT). This policy and practice review examines the strengths and shortcomings of these techniques in China, noting their potential to accelerate recovery. The findings offer insights for other countries and regions adopting rapid antidepressant strategies.