In a groundbreaking development, a recent study published in The New England Journal of Medicine suggests that ketamine, an anesthetic, could be a promising alternative to electroconvulsive therapy (ECT) for patients with hard-to-treat depression. This study is the largest head-to-head comparison of the two treatments to date.
Approximately one-third of clinically depressed patients, who do not respond to at least two antidepressants, suffer from what clinicians refer to as "treatment-resistant" depression. ECT, despite its long-established efficacy, is often underutilized due to historical misuse and associated stigma. However, this study found that intravenous ketamine was at least as effective as ECT in patients with treatment-resistant depression who do not have psychosis.
The study, sponsored by the Cleveland Clinic Foundation, involved 365 patients randomly assigned to receive either intravenous ketamine or ECT. Nearly half received ketamine twice a week, while the others received ECT three times a week. By the end of the three-week treatment, 55 percent of those in the ketamine group and 41 percent of the patients in the ECT group reported a 50 percent or greater reduction in symptoms.
Six months later, the quality-of-life scores for both groups were similar. However, the study noted that ECT was associated with memory problems, while ketamine was not. Ketamine also proved easier to administer, with fewer adjustments during treatment and fewer patients dropping out.
Despite these promising results, the study also highlighted potential risks. Longer treatment with ketamine increases the likelihood of drug dependence and cognitive adverse effects, including dissociation, paranoia, and other psychotic symptoms.
Researchers and clinicians are currently using intravenous ketamine off-label, as it has not been approved by the Food and Drug Administration for the treatment of mood disorders. A larger study comparing ECT to intravenous ketamine in 1,500 acutely suicidal and depressed patients is planned for later this year.
Story Source: The New York Times