JAMA Netw Open

ECT vs. ketamine for treatment-resistant depression: Which factors predict response?

June 28, 2024

Greater improvement in depression was observed with IV ketamine among outpatients with nonpsychotic treatment-resistant depression (TRD) who had moderately severe or severe depression, suggesting that these patients may consider ketamine over electroconvulsive therapy (ECT) for TRD.

• The study cohort included patients with TRD, ages 21 to 75 years, who were in a current nonpsychotic depressive episode of at least moderate severity and were referred for ECT. Participants were randomized 1:1 to receive either 6 infusions of ketamine (n=195) or 9 treatments with ECT over 3 weeks (n=170). The main outcome was an association between baseline factors (including 16-item Quick Inventory of Depressive Symptomatology Self-Report [QIDS-SR16], Montgomery-Asberg Depression Rating Scale [MADRS], premorbid intelligence, cognitive function, history of attempted suicide, and inpatient vs. outpatient status) and treatment response.
• In repeated measures mixed-effects models using depression levels over 3 weeks and after false discovery rate adjustment, participants with a baseline QIDS-SR16 score of ≤20 and those starting treatment as outpatients reported greater reduction in the QIDS-SR16 with ketamine vs. ECT.
• Conversely, those with a baseline QIDS-SR16 score of >20 (ie, very severe depression) and starting treatment as inpatients reported greater reduction in the QIDS-SR16 earlier in course of treatment with ECT, but scores were similar in both groups at the end-of-treatment visit.
• In the ECT group only, participants with higher scores on measures of premorbid intelligence and with a comorbid PTSD diagnosis reported greater reduction in the MADRS score. Those with impaired memory recall had greater reduction in MADRS during the second week of treatment, but the levels of MADRS were similar to those with unimpaired recall at the end-of-treatment visit.

Source:

Jha MK, et al. (2024, June 3). JAMA Netw Open. Ketamine vs Electroconvulsive Therapy for Treatment-Resistant Depression: A Secondary Analysis of a Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/38916891/