New Study Shows Ketamine for Depression May Be Better than ECT

Medical Reviewer: Nima A. Fahimian, MD

Published:

A new study conducted by researchers at Massachusetts General Brigham found ketamine to be a comparable and safer option to ECT for cases of severe treatment-resistant depression.

For decades, ECT has been considered the “gold standard” for severe depression treatment, due to its high efficacy rates. Most antidepressants and other depression treatments are only effective for about one-third of people, but ECT is at least 50% effective for individuals with treatment-resistant depression. For this reason, it has historically been considered one of the most reliably effective options for severe depression.

ECT has also, however, been associated with many undesirable side effects. Although ECT is much safer now than it has been in the past, it can still have detrimental impacts on neural function leading to side effects like memory loss. The treatment carries a negative social stigma and is sometimes unfavored because it requires anesthesia.

Ketamine is a relatively new depression treatment that is quickly rising in popularity in recent years. In 2019, the FDA approved a specific form of ketamine, known as esketamine, under the brand name Spravato. In clinical research, ketamine is proving to be more effective than standard antidepressants, and is notable for its unique mechanism of action and ability to provide relief for many months following a full treatment course.

In June 2023, researchers from Massachusetts General Brigham conducted the largest study to-date comparing ECT and ketamine treatment. The open-label, randomized trial had 403 total participants, all diagnosed with treatment-resistant major depression with no psychotic symptoms. Initially, 203 patients were assigned to receive ECT, and 200 patients were assigned to receive intravenous ketamine. Thirty-eight patients withdrew before the initial treatment, leaving 170 patients who received ECT and 195 who received ketamine.

Patients underwent a 3-week treatment phase, receiving either ketamine twice per week or ECT three times per week. To measure treatment response, the primary outcome, Quick Inventory of Depressive Symptomatology scores were recorded, with scores ranging from 0 to 27. Secondary outcome measurements included memory test scores and self-reported quality of life. Patients who showed a meaningful treatment response were followed over a 6-month period post-treatment.

Within the ketamine group, 55.4% of patients had a meaningful response, compared to 41.2% in the ECT group after 6 months. Patients who responded had at least a 50% decrease in depression symptoms, and improved quality of life throughout the 6-month period following treatment. Researchers concluded that ketamine is noninferior to ECT in effectiveness as a treatment for severe depression. Because the study design was a noninferiority trial, the researchers could not come to the conclusion that ketamine was more or less effective than ECT. However, the fact that ketamine had more treatment durability than ECT is a very significant finding that suggests that the response from ketamine persists for the majority of people over time.

As far as side effects, ECT was associated with memory loss after 3 weeks of treatment with gradual recovery, as well as adverse musculoskeletal effects. Ketamine was only associated with dissociation during treatments.

The results of the study are profound and promising for individuals with treatment-resistant depression. This data suggests that there may be a more tolerable treatment option that is just as effective as ECT for cases of depression that don’t respond to traditional medicine. The researchers noted that the open-label and self-report design of the study may have impacted results, and the team is working on a follow-up study to compare ECT and ketamine for individuals with acute suicidal depression.

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As someone who has struggled with depression for years, I was skeptical about trying alternative treatment options. However, the team at Bespoke Treatment made me feel comfortable and supported throughout the entire process. Not only did their TMS therapy provide significant relief for my depression symptoms, but I also had a positive experience with their ketamine therapy. The staff was incredibly knowledgeable and took the time to answer all of my questions and address any concerns I had.

I can't recommend this place enough. I had an incredible experience with the treatment I received here. From the administrative staff to the medical team, I really appreciated the outstanding care and attention I received and always felt listened to. There was never any sense of rushing or a "one size fits all" approach, which is sadly very much the norm elsewhere. I highly recommend coming here for the excellent quality of services, professionalism, and warmth that are so important when you're needing mental health treatment.

TMS was amazing for me . I loved my treatments , the doctors, the staff as well as the office itself. Its an amazing place to go for your wellbeing . Everyone is super nice, kind and extremely professional. The place is very easy to get to with available parking. Basically no stress. I felt very comfortable with my technician and all his knowledge about TMS . I also loved Dr. Fahimian . He is extremely educated and knowable in his field. His patience in taking his time to answer all my questions and concerns were highly appreciated.

I was severely depressed when starting treatment. I could not handle meds and had big hopes that TMS would work. It absolutely did wonders for lifting my depression. I have my life back. I have motivation to do things and energy to achieve goals. I really wasn’t sure if the TMS method would work, but it did and I am forever grateful. It even helped with my ruminating thoughts. I’m able to be in the moment and get back into doing things I enjoy. I highly recommend TMS to anyone who needs it.

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