KET or ECT for treatment-resistant depression?
Marie Spies, Siegfried Kasper, Richard Frey, Pia Baldinger-Melich
International journal of psychiatry in clinical practice 2024 DOI: 10.1080/13651501.2025.2462725 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Commentary Randomized Peer reviewed |
|---|---|
| Topics | Depression Ketamine |
| Keywords | Electroconvulsive therapy Inferiority Response Depression treatment Mental health therapy Psychiatric interventions Clinical procedures |
| Key points | Argues that treatment decisions for ECT or ketamine should be based on predictive clinical response markers and patient preferences, not on general superiority claims. |
Abstract
Modern electroconvulsive therapy (ECT) and ketamine currently represent the most effective treatment options in depressed patients showing non-response to two or more trials of antidepressants. Recently, large sample head-to-head comparisons of intravenous ketamine versus ECT for treatment-resistant depression (TRD) have fuelled the debate on which therapy might be more effective. However, the informative value of these studies is limited due to major methodological differences, especially regarding patients' baseline clinical characteristics and treatment procedures. This commentary, in reaction to the recently published article by Jha et al. 'Ketamine vs Electroconvulsive Therapy for Treatment-Resistant Depression: A Secondary Analysis of a Randomized Clinical Trial' in JAMA Network Open, addresses this issue and proposes that treatment decisions of ECT or ketamine should be based on substantiated, predictive clinical response markers and patient's preferences. It is undisputed that both treatments are highly effective in TRD, yet, given that ketamine is usually administered before ECT, efficacy studies of ECT in ketamine non-responders are urgently warranted.KEYPOINTSModern electroconvulsive therapy (ECT) and ketamine currently represent the most effective treatment options in treatment-resistant depressionHead-to-head comparisons of both treatments have yielded incongruent findings due to differing patients' baseline clinical characteristics and treatment proceduresTreatment-decisions of ECT or ketamine should be based on predictive clinical response markers and patient's preferences while considering the specific side effect profiles of both optionsFuture prospective studies should assess the efficacy of ECT in ketamine non-responders.