1. Electroconvulsive therapy (ECT) was associated with fewer depressive symptoms than ketamine in this systematic review and meta-analysis.
2. However, studies that assessed cognition/memory or serious adverse events found no significant differences between ECT and ketamine.
Evidence Rating Level: 1 (excellent)
Electroconvulsive therapy (ECT) is the gold standard for treating treatment-resistant major depression (TRD). However, ECT is underutilized due to various professional and patient-related barriers. Instead, intravenously delivered ketamine shows promise for effectively treating TRD. Currently, there are no studies that quantify and compare the effect size, safety, and efficacy of ECT and ketamine. Consequently, the aim of this systematic review and meta-analysis was to compare these two treatments in patients with major depressive disorder.
Of the 1248 articles screened, 6 trials (n=340 patients, 162 with ECT, 178 with ketamine) from database inception to April 2022 were included. Studies that evaluated the effects of ECT or ketamine on depressive symptoms in patients meeting diagnostic criteria for major depressive disorder were included. Studies were excluded if they used non-human participants and if they did not use standardized measures of depression. Risk of bias and study quality were assessed using the Cochrane Collaboration Risk of Bias tool. Improvement in depressive symptoms was calculated using the Hedges g standardized mean difference (SMD) and fixed or random effects models. This review was conducted according to PRISMA guidelines. The primary outcome was improvement in depression symptoms and severity.
Results showed that ECT was superior to ketamine in a range of depressive symptoms measured. However, three studies showed that ketamine had faster antidepressant effects than ECT. Ketamine had a lower risk of certain adverse events such as headache and myalgia, and ECT had a lower risk of visual impairment, dizziness, diplopia, etc. Due to the small sample size of the study, which may have led to underpower. Nonetheless, the results of this review highlight the potential superiority of ECT to ketamine in improving depressive symptoms.
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