Researchers at Lund University in Sweden compared the effects of intravenous ketamine treatment with ECT treatment in severe depression. The results support the view that ketamine is a possible treatment, but also show that treatment with ECT is helping more people.
In recent years, ketamine has become a new treatment for depression, after studies showed it to be a fast-acting antidepressant.
“However, the previous studies were all small with a short follow-up period, so this is the first large randomized clinical study,” says Pouya Movahed Rad, Lund University researcher and consultant psychiatrist, who has led the study.
Researchers looked at the antidepressant effect of ketamine and compared it to ECT (electroconvulsive therapy), currently the treatment of choice for very severe depression.
“Ketamine is a controlled drug and must be administered under supervision, while ECT can cause temporary memory side effects and is resource-intensive as the patient must be anesthetized,” says Pouya Movahed Rad.
A total of 63% of patients in the ECT group recovered after treatment, compared with 46% of those who received racemic ketamine intravenously.
While ECT and ketamine can successfully treat a severely depressed patient, they will not always cure the underlying illness because depression is usually recurrent. About as large a proportion in the ECT group as in the ketamine group had a relapse within 12 months.
“We haven’t seen the quick effect of ketamine that other studies have shown. Instead, our results indicate that the effect is cumulative and increases with the number of treatments. Older people generally responded less well to ketamine, while younger people responded too. to ECT as to ketamine, ”explains Pouya Movahed Rad.
Six treatment sessions were necessary for both treatments in order to have a full recovery. More ketamine treatment participants opted out of the study than in the ECT group.
The group we studied had been offered ECT, but about half of them were now randomized to participate in the intravenous ketamine group. Perhaps this was important because some of the participants chose to stop ketamine treatment prematurely. “
Pouya Movahed Rad, researcher, University of Lund
In the group that received ECT, however, it was somewhat more common with persistent memory difficulties.
“Our results suggest that intravenous ketamine does not cause serious side effects in this group of patients. No treatment should be overused, but ketamine should be an acceptable alternative for patients with severe depression. We want to continue studying. the blood samples and other data that we have collected, to see if we can find markers that help us choose the right treatment for the right patient, ”concludes Pouya Movahed Rad.
Ekstrand, J., et al. (2021) Racemic ketamine as an alternative to electroconvulsive therapy for unipolar depression: a randomized, open-label, non-inferiority trial (KetECT). International Journal of Neuropsychopharmacology. doi.org/10.1093/ijnp/pyab088.