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Wednesday, June 7, 2023

No more shocks? Study shows drug treatment for major depression just as effective as electroconvulsive therapy

CLEVELAND, Ohio— The anesthetic drug ketamine is at least as effective as electroconvulsive therapy for treating major depression and has fewer side effects, a study published Wednesday in the New England Journal of Medicine reported.

More than 21 million adults in the US are estimated to suffer from Major Depressive Disorder. For those whose depression fails to respond to anti-depressive drugs, ECT, which involves inducing a seizure via electrical stimulation of the brain, is one of the few treatments that can provide life-changing relief.

“ECT has been the gold standard for treating severe depression for over 80 years,” said Dr. Amit Anand, lead author on the study, a professor of psychiatry at Harvard Medical School and former vice-chair for research at Cleveland Clinic’s Center for Behavioral Health.

“But it is also a controversial treatment because it can cause memory loss, requires anesthesia and is associated with social stigma,” he said.

By comparison, ketamine is a low-cost drug approved by the Food and Drug Administration for sedation, pain relief, and as a general anesthetic. The drug has also been at the center of its own controversy because the drug, also known as “special K,” is abused recreationally for its hallucinogenic properties.

Previous studies have suggested that low doses of ketamine may have rapid antidepressant effects for people with MDD, but few have compared it to other treatments.

The clinical trial of 403 patients is the largest study ever done comparing ketamine and ECT treatments for depression that has ever been done, and the only one that also measured impacts to memory, Anand said.

The trial, conducted over five years across multiple institutions including the Cleveland Clinic, compared the outcomes of patients selected at random to either receive ECT three times per week or ketamine twice per week for three weeks. Following treatment, patients answered questions about their depressive symptoms and quality of life, along with a battery of memory tests for the next six months.

Investigators found that 55% of patients who received ketamine and 41% who received ECT reported at least a 50% improvement in their self-reported depressive symptoms and quality of life that lasted at least six-months and concluded that treatments with ketamine were as effective as ECT.

Additionally, ECT treatment was associated with memory loss and muscle and jaw pain. By comparison, the only side effects reported for ketamine treatment was its hallucinogenic effects during the treatment.

“For the ever-growing number of patients who do not respond to conventional psychiatric treatments and need a higher level of care, ECT continues to be the most effective treatment in treatment-resistant depression,” said Dr. Murat Altinay, a psychiatrist and lead of the trial site at Cleveland Clinic. “This study shows us that intravenous ketamine was non-inferior to ECT for treatment of non-psychotic treatment resistant depression and could be considered as a suitable alternative treatment for the condition.”

Anand’s team is now working on a follow-up study comparing ECT and ketamine treatments for patients with acute suicidal depression to see if the same promising impact is seen in that population.

“People with treatment-resistant depression suffer a great deal, so it is exciting that studies like this are adding new options for them,” said Anand. “With this real-world trial, the results are immediately transferable to the clinical setting.”

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