Comparing the effects of ECT and intravenous ketamine in psychiatric patients with major depressive episodes.
Julia Myerson, Katrina A Rufino, Sanjay J. Mathew, Marie Fletcher, Neil Puri, Hyuntaek Oh
Journal of Affective Disorders June 18, 2025 DOI: 10.1016/j.jad.2025.119727 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Retrospective chart review Randomized Open-label Peer reviewed |
|---|---|
| Sample size | 146 |
| Population | Inpatients and outpatients aged 18 to 74 with major depressive episodes |
| Interventions | Electroconvulsive therapy Intravenous ketamine |
| Dose | subanesthetic IV ketamine infusions |
| Duration | Up to three weeks |
| Topics | Depression Ketamine Esketamine |
| Keywords | Effectiveness Major depressive episodes Mental health treatment Mood disorder therapy Ect: electroconvulsive therapy Electroshock therapy Brain stimulation therapy Ketamine: ketamine therapy Rapid-acting antidepressant Treatment outcomes Therapeutic efficacy Response rates Clinical impact |
| Key findings | ECT demonstrated more robust antidepressant effects than intravenous ketamine, with higher response and remission rates. |
Abstract
Electroconvulsive therapy (ECT) and intravenous (IV) ketamine are treatments used for severe depression and/or treatment-resistant depression (TRD). ECT is considered one of the most effective treatments for severe depression, although there is debate within the field regarding the effectiveness between ECT and IV ketamine in comparable TRD patient groups. This retrospective chart review of open-label, nonrandomized treatment from a psychiatric hospital compared the effects of up to three weeks of ECT and IV ketamine in patients with major depressive episodes (MDEs). Our cohort included 146 inpatients and outpatients aged 18 to 74 years old. 94 patients received subanesthetic IV ketamine infusions 2 times a week, and 52 patients received ECT treatment 2-3 times a week. The primary outcome measure was the Montgomery-Asberg Depression Rating Scale (MADRS). Overall on the MADRS, 45.2 % of participants showed clinical symptom change between the beginning of treatment compared to the end of treatment, while 54.8 % did not. Reliable change index (RCI) analysis indicated 58.9 % showed significant symptom change, while 41.1 % did not. Chi-Square tests revealed significant associations between treatment type and clinical symptom change on the MADRS, with patients who received ECT showing greater symptom improvement compared to those who received ketamine (p < .05). Response rates of ECT and ketamine were 67.3 % and 45.7 %, respectively, whereas remission rates for ECT and ketamine were 60.0 % and 46.1 %, respectively. ECT demonstrated the more robust antidepressant effects compared to ketamine. Randomized comparative trials are required to gain a better understanding of these modalities.
Comparable studies
Other observational and cohort studies on ketamine for depression, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Concomitant BDNF and sleep slow wave changes indicate ketamine-induced plasticity in major depressive disorder Patients with treatment-resistant major depressive disorder | 2012 | Observational cohort | n = 30 |
| Altered peripheral immune profiles in treatment-resistant depression: response to ketamine and prediction of treatment outcome Healthy controls and actively depressed patients with treatment-resistant depression... | 2017 | Observational cohort | n = 59 |
| Clinical Predictors of Ketamine Response in Treatment-Resistant Major Depression Treatment-resistant inpatients with DSM-IV-TR-diagnosed major depressive disorder or... | 2014 | Post hoc analysis of pooled data from four studies | n = 108 |
| An investigation of amino-acid neurotransmitters as potential predictors of clinical improvement to ketamine in depression Drug-free patients with major depressive disorder | 2011 | Observational cohort | n = 14 |
| Efficacy of ketamine therapy in the treatment of depression Drug-free/naïve men with severe depression, no history of psychotic disorder, head... | 2019 | Observational cohort | n = 25 |