Outcomes of patients receiving interventional psychiatric procedures in a large integrated healthcare system.
Kevin J Li, Natalie E Slama, Ingrid L Chen, Samuel Ridout, Esti Iturralde
Psychiatry Research July 19, 2025 DOI: 10.1016/j.psychres.2025.116647 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Observational cohort Longitudinal Peer reviewed |
|---|---|
| Sample size | 22,481 |
| Population | Patients with treatment-resistant depression in a large integrated healthcare system |
| Interventions | Electroconvulsive therapy Transcranial magnetic stimulation Ketamine intravenous treatments Medication management |
| Duration | 6-week intervention, 12-month follow-up for hospitalization risk |
| Topics | Depression Esketamine Ketamine |
| Keywords | Electroconvulsive therapy Iv ketamine Tms Trd Transcranial magnetic stimulation Bipolar disorder Integrated healthcare system Ketamine infusions Treatment resistant depression Psychiatric interventions Interventional procedures Depressive disorders Healthcare systems research |
| Citations | 2 |
| Key findings | Interventional psychiatric procedures (ECT, TMS, and ketamine) each produced significantly greater depression improvement at six weeks than standard medication management, and continuation/maintenance ketamine was associated with a lower risk of psychiatric hospitalization. |
Abstract
Interventional psychiatric procedures (IPPs) such as electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and ketamine intravenous treatments (KIT) are widely used for treatment resistant depression (TRD), but we lack studies of their real-world impact compared to standard outpatient medication management (MM). Longitudinal electronic health records of 22,481 patients in a large integrated healthcare system during 2018-2022 were examined to describe depression improvement via 9-item Patient Health Questionnaire (PHQ-9), changes in psychiatric admissions, and use of continuation/maintenance (C/M) treatments. Overall, each IPP group had significantly greater depression improvement at 6 weeks compared to MM: adjusted estimates TMS:1.64 (p < 0.001), KIT:2.02 (p < 0.001), and ECT:2.16 (p < 0.001). Patient characteristics were associated with symptom worsening within treatment groups, for example: (1) non-white race for ECT (2.33, p < 0.01) and MM (0.29, p < 0.001); (2) anxiety disorder for TMS (1.73, p < 0.001); and (3) personality disorder for all treatment groups, with significant coefficients found for KIT (3.27, p < 0.05) and MM (1.27, p < 0.001). Some examples of correlations with improved symptom response include: (1) psychotic disorder for ECT (-3.57, p < 0.01); and (2) bipolar disorder for KIT (-2.19; p < 0.05). For the KIT group, C/M treatment versus no C/M treatment was associated with lower risk for 12-month psychiatric hospitalization (adjusted relative risk: 0.25). This is the first study to show a protective association for maintenance ketamine on psychiatric hospitalization risk. Treatment-specific predictors of response should be confirmed in future comparative effectiveness studies.
Comparable studies
Other observational and cohort studies on esketamine for depression, most cited first.
Citations in the library
Cited by 2
- Interdisciplinary, Delphi-driven consensus guidelines on the use of intravenous ketamine infusions for depressive disorders from the American Society of Ketamine Physicians, Psychotherapists, and Practitioners (ASKP3). Journal of Affective Disorders May 16, 2026
- Progress, potential and pitfalls of ketamine as a treatment for depression Expert Opinion on Pharmacotherapy January 22, 2026
Cites 13
- Ketamine versus ECT for Nonpsychotic Treatment-Resistant Major Depression. New England Journal of Medicine May 24, 2023
- Repeat-dose ketamine augmentation for treatment-resistant depression with chronic suicidal ideation: A randomized, double blind, placebo controlled trial. Journal of Affective Disorders 2019
- Maintenance ketamine treatment for depression: a systematic review of efficacy, safety, and tolerability. The Lancet Psychiatry November 1, 2022
- Efficacy and Safety of Ketamine vs Electroconvulsive Therapy Among Patients With Major Depressive Episode: A Systematic Review and Meta-analysis. JAMA Psychiatry October 19, 2022
- Racemic Ketamine as an Alternative to Electroconvulsive Therapy for Unipolar Depression: A Randomized, Open-Label, Non-Inferiority Trial (KetECT) The International Journal of Neuropsychopharmacology December 4, 2021
and 8 more in the library