Treating major depressive disorder without psychotic features: subanesthetic ketamine versus electroconvulsive therapy
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Reviewed by Dat Tien Nguyen, B.A, ScM.
Translated by An Duc Thien Le |
Posted on July 19th, 2023
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For nearly a century, electroconvulsive therapy (ECT) had been the standard treatment for major depressive disorder. Despite its effectiveness, application of ECT is still limited due to social stigma, the need for anesthesia, and the elevated risk of cognitive impairment. In the recent decades, ketamine has also been used as an antidepressant treatment for patients without psychotic features. However, it is currently unknown if one treatment is inferior to the other; thus, a study has been conducted to compare the effectiveness in treating nonpsychotic major depressive disorder between ECT and ketamine.
The study included 403 patients between the age of 21 and 75, who have been diagnosed with treatment-resistant major depression without psychotic features using the criteria set by the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). Assessment using the Montgomery–Åsberg Depression Rating Scale (MADRS) was performed to choose patients who have moderate to severe depression - score higher than 20 on the 60-point scale. Half of the patients were given ketamine intravenously at a subanesthetic dose of 0.5 mg per kilogram of bodyweight twice per week. The other half received unilateral electroconvulsive therapy at six times the seizure threshold three times per week. After 3 weeks of treatment, the study found that 55.4% of the patients in the ketamine group and 41.2% of the patients in the electroconvulsive therapy group experience a significant clinical improvement, as measured by the QIDS-SR-16 scale. The researchers observed that participants in both groups reported similar enhancement to their quality of life throughout the 6-month follow-up period. Patients who received electroconvulsive therapy experience an elevated risk of memory impairment, when compared to the ketamine treatment. Other relevant safety outcomes included a higher incidence of musculoskeletal adverse effects reported by those in the ECT group and ketamine increased the frequency of dissociative episodes.
The study included 403 patients between the age of 21 and 75, who have been diagnosed with treatment-resistant major depression without psychotic features using the criteria set by the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). Assessment using the Montgomery–Åsberg Depression Rating Scale (MADRS) was performed to choose patients who have moderate to severe depression - score higher than 20 on the 60-point scale. Half of the patients were given ketamine intravenously at a subanesthetic dose of 0.5 mg per kilogram of bodyweight twice per week. The other half received unilateral electroconvulsive therapy at six times the seizure threshold three times per week. After 3 weeks of treatment, the study found that 55.4% of the patients in the ketamine group and 41.2% of the patients in the electroconvulsive therapy group experience a significant clinical improvement, as measured by the QIDS-SR-16 scale. The researchers observed that participants in both groups reported similar enhancement to their quality of life throughout the 6-month follow-up period. Patients who received electroconvulsive therapy experience an elevated risk of memory impairment, when compared to the ketamine treatment. Other relevant safety outcomes included a higher incidence of musculoskeletal adverse effects reported by those in the ECT group and ketamine increased the frequency of dissociative episodes.