Ketamine and electroconvulsive therapy for severe depression: A network meta-analysis of efficacy and safety.
Yecun Liu, Jiguo Yang, Yuanxiang Liu
Journal of Psychiatric Research July 1, 2024 DOI: 10.1016/j.jpsychires.2024.05.022 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review and network meta-analysis Randomized Peer reviewed |
|---|---|
| Sample size | 1,370 |
| Population | Patients with severe depression |
| Interventions | Ketamine Electroconvulsive therapy |
| Topics | Ketamine Depression Esketamine |
| Keywords | Electroconvulsive therapy Network meta-analysis Severe depression Depression treatment Clinical research Psychiatric therapy Mental health interventions Neuroscience advances |
| Citations | 8 |
| Key findings | Electroconvulsive therapy is superior to ketamine and their combination for improving depressive severity, though individualized treatment selection is warranted. |
Abstract
Ketamine, electroconvulsive therapy (ECT), and their combination are effective for treating severe depression, but few large-scale studies have compared these. We searched databases for randomized controlled trials (RCTs) using ketamine, ECT, ketamine + ECT, or placebo for severe depression. Standardized measures were efficacy outcomes. Risk of bias was assessed. Stata and ADDIS were used for network meta-analysis (NMA) comparing efficacy and adverse reactions post-treatment. This study was registered on PROSPERO (CRD42023476740). 17 RCTs with 1370 patients were included. NMA showed ECT and ketamine improved Hamilton Depression Rating Scale (HDRS) versus placebo; other comparisons not significant. Rank probabilities showed highest probability for ECT, followed by ketamine + ECT, ketamine, placebo. No differences in Montgomery-Asberg Depression Rating Scale (MADRS); highest rank probability again for ECT, followed by ketamine + ECT, ketamine, placebo. Analysis suggests ECT superior to ketamine and their combination for improving depressive severity, but individualized treatment selection warranted. Higher adverse reactions with ketamine + ECT need further study for optimized combined use.
Comparable studies
Other systematic reviews and meta-analyses on ketamine for depression, most cited first.
Citations in the library
Cited by 5
- Improving access to novel treatments for treatment-resistant depression: The potential role of specialist clinics in Australia Australian & New Zealand Journal of Psychiatry May 26, 2026
- Time matters for metas: a systematic review and meta-analysis of ect vs ketamine for depression incorporating time. Translational Psychiatry January 23, 2026
- Ketamine or Electroconvulsive Therapy as Treatment Approach to Severe Depression: The Necessity of More Personalized Management Ketamine 2025
- KET or ECT for treatment-resistant depression? International Journal of Psychiatry in Clinical Practice 2024
- A systematic review and meta-analysis of the efficacy of ketamine compared to electroconvulsive therapy for treatment-resistant depression. International Journal of Psychiatry in Clinical Practice March 2026
Cites 27
- Antidepressant Efficacy of Ketamine in Treatment-Resistant Major Depression: A Two-Site Randomized Controlled Trial American Journal of Psychiatry August 28, 2013
- Efficacy and Safety of Intranasal Esketamine for the Rapid Reduction of Symptoms of Depression and Suicidality in Patients at Imminent Risk for Suicide: Results of a Double-Blind, Randomized, Placebo-Controlled Study American Journal of Psychiatry April 16, 2018
- Side-effects associated with ketamine use in depression: a systematic review. The Lancet Psychiatry 2018
- Ketamine for rapid reduction of suicidal ideation: a randomized controlled trial Psychological Medicine August 12, 2015
- Ketamine versus ECT for Nonpsychotic Treatment-Resistant Major Depression. New England Journal of Medicine May 24, 2023
and 22 more in the library