Ketamine versus electroconvulsive therapy for major depressive episode: An updated systematic review and non-inferiority meta-analysis.
Arthur Bezerra Cavalcanti Petrucci, João Vitor Andrade Fernandes, Isabelle Albuquerque Reis, Giovanna Hanike Santos da Silva, Brenda Maria Folli Recla, Juliana Celga de Mendonça, Victória Carvalho Souto Pedro, Luís Eduardo Negreiros D'Assunção, Leandro da Costa Lane Valiengo
Psychiatry Research September 1, 2024 DOI: 10.1016/j.psychres.2024.115994 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review and meta-analysis Randomized Peer reviewed |
|---|---|
| Sample size | 655 |
| Population | Patients with major depressive episodes |
| Interventions | Ketamine Electroconvulsive therapy |
| Topics | Depression Ketamine Esketamine |
| Keywords | Anesthetic Antidepressant Mood disorders Mood disorder treatment Ketamine therapy Electroconvulsive therapy ect Electroshock therapy Comparative efficacy |
| Citations | 18 |
| Key findings | Ketamine was not non-inferior to ECT in response rate for major depressive episodes, and among inpatients ketamine was inferior to ECT. |
Abstract
We conducted a systematic review and meta-analysis to investigate the comparative effectiveness of ketamine versus electroconvulsive therapy (ECT) for the treatment of major depressive episodes (MDEs). PubMed, EMBASE and Cochrane Library databases were systematically searched for randomized controlled trials (RCTs) comparing ketamine and ECT for MDE. The primary outcome was response rate, for which we prespecified a non-inferiority margin of -0.1, based on the largest and most recent RCT. Response was defined as a reduction of at least 50 % in the depression scale score. Six RCTs met the inclusion criteria, comprising 655 patients. In the overall population, ketamine was not non-inferior to ECT in response rate (RD -0.10; 95 % CI -0.26 to 0.05; p = 0.198; I2 = 72 %). The ECT group had a higher reduction in depression scores, but without difference in remission and relapse rates. Regarding safety outcomes, ketamine had better posttreatment cognition scores and reduced muscle pain rate compared with ECT, albeit with an increased rate of dissociative symptoms. In a subanalysis with only inpatients, ketamine was inferior to ECT in response rate (RD -0.15; 95 % CI -0.27 to -0.03; p = 0.014; I2 = 25 %), remission, and change in depression scores. These findings support the use of ECT over ketamine for inpatients. Further RCTs are warranted to clarify the comparative effect of these treatments for outpatients.
Comparable studies
Other systematic reviews and meta-analyses on ketamine for depression, most cited first.