Comparison of Rapid Antidepressant and Antisuicidal Effects of Intramuscular Ketamine, Oral Ketamine, and Electroconvulsive Therapy in Patients With Major Depressive Disorder
Dorna Kheirabadi, Gholam Reza Kheirabadi, Zahra Mirlohi, Mohammad Javad Tarrahi, Amir Norbaksh
Journal of Clinical Psychopharmacology November 1, 2020 DOI: 10.1097/jcp.0000000000001289 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Pilot study Peer reviewed |
|---|---|
| Sample size | 45 |
| Population | Adults aged 18 to 70 years with major depressive disorder who were candidates for ECT |
| Interventions | Intramuscular ketamine Oral ketamine Electroconvulsive therapy |
| Dose | 0.5 mg/kg of IM ketamine; 1 mg/kg of oral ketamine |
| Duration | 6 to 9 sessions during 3 weeks, with follow-up at 1 week and 1 month after the intervention |
| Topics | Depression Esketamine Ketamine |
| Citations | 49 |
| Key findings | Oral and intramuscular ketamine showed similar antidepressant and possibly greater antisuicidal effects compared with ECT, with fewer cognitive adverse effects and higher patient preference. |
Abstract
Abstract Purpose/Background This study was devised to compare the antidepressant and antisuicidal effects of oral and intramuscular (IM) ketamine versus electroconvulsive therapy (ECT). Methods/Procedures In our pilot study, 45 patients with major depressive disorder (based on Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria) in the age range of 18 to 70 years who were determined suitable candidates for ECT got randomly divided into 3 equal groups. Each group received one of these treatment modalities: 0.5 mg/kg of IM ketamine; 1 mg/kg of oral ketamine; and ECT in 6 to 9 sessions during 3 weeks. Depression and suicidal ideation scores were recorded using the Hamilton Depression Rating Scale and the Beck Scale for Suicidal Ideation, respectively, at baseline, 24 hours, 1 week, 2 weeks, and 3 weeks within the intervention. The measurements were repeated 1 week and 1 month after the end of the intervention as well. Vital signs and adverse effects were noted. Finally, satisfaction levels of patients for each method were recorded and compared between groups. Findings/Results The Hamilton Depression Rating Scale and the Beck Scale for Suicidal Ideation scores significantly improved in all groups compared with baseline with no significant differences between the 3 groups. The adverse effects for ketamine-consuming groups such as dissociative symptoms were brief and transient, whereas memory loss for the ECT group remained up to 1 month in some patients. Ketamine-receiving groups preferred it more than ECT. Implications/Conclusions Oral and IM ketamine probably have equal antidepressant in addition to more antisuicidal effects compared with ECT but had less cognitive adverse effects and higher preference by patients. Thereby, ketamine can be an alternative method in the treatment of patients with severe and/or suicidal MDD.
Comparable studies
Other randomized controlled trials on ketamine for depression, most cited first.