Another review driven by specialists from Mass General Brigham has found that subanesthetic intravenous ketamine was powerful and not substandard compared to electroconvulsive treatment (ECT) for the treatment of non-crazy, treatment-safe misery. The New England Journal of Medicine contains their findings.
Amit Anand, MD, professor of psychiatry at Harvard Medical School and director of Psychiatry Translational Clinical Trials at Mass General Brigham, stated, “ECT has been the gold standard for treating severe depression for over 80 years.” Be that as it may, it is likewise a dubious treatment since it can cause cognitive decline, requires sedation, and is related to social shame. This is the largest and only study to measure the effects on memory of ketamine and electroconvulsive therapy (ECT) treatments for depression.
It is estimated that 21 million adults in the United States suffer from major depressive disorder (MDD), which is the leading cause of disability worldwide. Through electrical stimulation of the brain, ECT causes a seizure. The Food and Drug Administration has granted approval to ketamine, a low-cost dissociative drug, as a sedative, analgesic, and general anesthetic. Past investigations have proposed that low dosages of the medication might have rapid upper-level impacts for individuals with MDD.
“This study demonstrates that intravenous ketamine is a viable alternative to ECT for treating non-psychotic treatment-resistant depression and was not significantly worse than it.”
Murat Altinay, MD, Psychiatrist and lead of the trial site at Cleveland Clinic.
From March 2017 to September 2022, 403 patients were randomized one-to-one to receive ECT three times per week or ketamine twice per week for three weeks at five different locations. A depressive symptom self-assessment questionnaire, which also included memory tests and questions about quality of life, was completed by patients six months after treatment.
The scientists found that 55% of those getting ketamine and 41 percent of those getting ECT experienced essentially a 50 percent improvement in their self-revealed burdensome side effects and an improvement in their self-detailed personal satisfaction that endured all through the half-year checking period. Memory loss and adverse effects on the musculoskeletal system were linked to ECT treatment. Other than a brief dissociation during treatment, ketoacidosis was not associated with any adverse effects.
“ECT continues to be the most effective treatment for treatment-resistant depression for the ever-growing number of patients who do not respond to conventional psychiatric treatments and need a higher level of care,” stated Murat Altinay, MD, psychiatrist and lead of the trial site at Cleveland Clinic. “This study demonstrates that intravenous ketamine is not inferior to ECT in the treatment of non-psychotic treatment-resistant depression and may be considered an appropriate alternative treatment.”
The current study is the largest-ever real-world comparison of ECT and ketamine’s effectiveness. The preliminary adopted a patient-focused strategy, with three sorts of free misery evaluations (patient, rater, and clinician) caught and no dynamic sales of members.
The trial’s open-label design may have affected response rates, and the authors point out that their findings are based on self-reported outcomes. However, the preliminary’s patient-centeredness and this present reality configuration may likewise be strengths, permitting the discoveries to be all the more effectively converted into clinical practice.
Now, Anand’s team is working on a follow-up study that will compare ECT and ketamine treatments for patients with acute suicidal depression to see if they have the same promising effect.
According to Anand, “it is exciting that studies like this are adding new options for them” because “people with treatment-resistant depression suffer greatly.” The findings of this real-world trial can be immediately applied in clinical settings.
More information: Anand, A. et al. ECT vs. Ketamine for Non-psychotic Treatment-Resistant Major Depression., New England Journal of Medicine (2023). DOI: 10.1056/NEJMoa2302399
