Electroconvulsive therapy, which is portrayed unfavorably in movies and TV shows, consistently produces better outcomes for treatment-resistant depression.
According to an analysis of six studies that recently published their results in JAMA Psychiatryelectroconvulsive therapy (ECT) is better than ketamine for rapid relief of major depression.
According to the World Health Organization, depression is a widespread disease that affects approximately 5% of individuals worldwide (WHO). Feeling sad, irritable, losing pleasure in once delicious things, and even enduring weeks of inexplicable pain or fatigue are all signs of depression. The most common first-line treatment for depression is the use of an oral antidepressant (in conjunction with psychotherapy). However, if oral antidepressants are ineffective or the patient is in immediate danger of self-harm, there are other, faster treatment options, including ECT and, more recently, ketamine or esketamine.
Ketamine is used less often in the United States than esketamine, a nasal spray that has been approved by the Food and Drug Administration to treat depression. However, there are no studies comparing the effectiveness of ECT with esketamine. Ketamine, a sister drug to esketamine, has been studied. Ketamine is typically used as an injectable anesthetic in medicine, but it has recently been studied as a fast-acting intervention to help people with severe depression.
T. Greg Rhee, a psychiatric epidemiologist at the University of Connecticut School of Medicine, and associates at Harvard University, Kyungnam University in Korea, McLean Hospital, and Massachusetts General Hospital in Boston, University of Toronto, VA New England Mental Illness in West Haven, and Yale University reviewed six global clinical studies comparing ketamine to ECT for major depression. The trials, which were conducted at hospitals in Sweden, Germany, Iran and India, involved a total of 340 patients.
All six studies independently showed that ECT was more effective than ketamine in relieving symptoms of severe depression.
“ECT is consistently more effective than ketamine” in helping patients with severe depression, says Rhee. “We found no differences by age, gender, or geographic location. So we could say that anyone eligible for ECT will benefit.
Although ketamine generally helped patients, ECT had better results overall. Ketamine could be a viable treatment for people who cannot undergo ECT. The side effect profiles of the two treatments differed, with ECT more likely to cause headaches, muscle aches, and memory loss, while ketamine was more likely to cause dissociative symptoms, dizziness. and double vision.
Two additional studies comparing ECT and ketamine are underway, and Rhee hopes to add their data to the analysis when they become available.
“Every study directly reports that ECT works better than ketamine. But people are still skeptical of ECT, maybe because of the stigma,” Rhee says, or negative portrayals in movies like ‘Flight Over the Cuckoo’s Nest’ and shows like ‘Stranger Things’ “We need to improve public awareness of ECT for treatment-resistant depression.”
Reference: “Efficacy and Safety of Ketamine Versus Electroconvulsive Therapy in Patients with Major Depressive Episode: A Systematic Review and Meta-Analysis” by Taeho Greg Rhee, Ph.D., Sung Ryul Shim, Ph. .D., Brent P. Forester, MD, MSc, Andrew A. Nierenberg, MD, Roger S. McIntyre, MD, George I. Papakostas, MD, John H. Krystal, MD, Gerard Sanacora, MD, Ph.D. and Samuel T. Wilkinson, MD, October 19, 2022, JAMA Psychiatry.
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