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The following is a summary of “Ketamine versus electroconvulsive therapy for major depressive episode: An updated systematic review and non-inferiority meta-analysis,” published in the September 2024 issue of Psychiatry by Petrucci et al.
Major depressive episodes (MDEs) are treated with various methods, including ketamine and electroconvulsive therapy (ECT). Comparing the effectiveness of these treatments could help improve therapeutic decisions.
Researchers started a retrospective study to investigate the comparative effectiveness of ketamine versus ECT for the treatment of MDEs.
They systematically reviewed PubMed, EMBASE, and the Cochrane Library databases for randomized controlled trials (RCTs) comparing ketamine and ECT for MDE. The main focus was the response rate, with a prespecified non-inferiority margin of -0.1, based on the largest and most recent RCT. The response was defined as a reduction of at least 50% in the depression scale score.
The results showed that 6 RCTs met the inclusion criteria, including 655 patients. In the overall population, ketamine was not non-inferior to ECT in response rate (RD -0.10, 95% CI: -0.26 to 0.05; P= 0.198; I2= 72%). The ECT group had a greater reduction in depression scores. However, no significant difference was found in remission and relapse rates. Regarding safety outcomes, ketamine resulted in better posttreatment cognition scores and reduced muscle pain compared with ECT but was associated with a higher rate of dissociative symptoms. In a subanalysis focusing on inpatients, ketamine was inferior to ECT in response rate (RD -0.15; 95% CI -0.27 to -0.03; P= 0.014; I2= 25%), remission, and change in depression scores.
Investigators concluded that ECT showed superior efficacy to ketamine for inpatients. However, further randomized controlled trials are warranted to clarify the comparative effects of treatments for outpatients.
Source: sciencedirect.com/science/article/abs/pii/S0165178124002798
