Ketamine versus ECT for nonpsychotic major depression
In the NEJM recently Anand et al carried out a RCT of ketamine versus ECT (electro-convulsive therapy) in major depression.
Method. Patients with treatment-resistant major depression without psychosis were recruited and assigned to receive ketamine or ECT. During an initial 3-week treatment phase, patients received either ECT three times per week or ketamine (0.5 mg per kilogram of body weight) twice per week.
The primary outcome was a response to treatment (i.e., a decrease of ≥50% from baseline in the score on the 16-item Quick Inventory of Depressive Symptomatology–Self-Report).
Results. A total of 403 patients underwent randomisation at five clinical sites; 200 patients were assigned to the ketamine group and 203 to the ECT group. A total of 55.4% of the patients in the ketamine group and 41.2% of those in the ECT group had a response (difference, 14.2 percentage points; 95% confidence interval, 3.9 to 24.2; P<0.001).
Improvement in patient-reported quality-of-life was similar in the two trial groups. ECT was associated with musculoskeletal adverse effects, whereas ketamine was associated with dissociation.
Conclusion. Ketamine was as good or better than ECT as therapy for treatment-resistant major depression without psychosis.
