According to a recent study, electroconvulsive therapy, also referred to as ECT, which is currently one of the fastest and most efficient treatments for people with serious depression, may be a good option for some patients.
The research represents the largest side-by-side comparison of the two therapies.
Around a third of clinically depressed people have a condition known as “treatment resistant” depression if they do not improve after taking at least 2 antidepressants.
The long-established effectiveness of ECT is typically recommended for up to twelve sessions, but it has a bad reputation due to historical abuse and a longtime scary Hollywood portrayal.
The procedure is still underutilized despite the fact that modern ECT is much safer and performed under general anesthesia today.
In patients with treatment-resistant depression who don’t also have psychosis, the study, which was published in The New England Journal of Medicine, found that ketamine, when given intravenously, was just as effective as ECT if not even more so in some cases.
Lead researcher Dr. Amit Anand said, “The results were very surprising to us.”
Initially, his team predicted that ketamine would be almost as efficient as ECT. However, they discovered that ketamine performed better, according to Dr. Anand.
This is important because some patients find ECT’s side effects, including momentary memory loss, muscle aches, or weakness, to be rather unsettling.
According to Dr. Anand, the study demonstrates that ketamine is simpler to administer and requires fewer adjustments throughout treatment than other drugs.
More significantly, it demonstrates that ketamine isn’t associated with memory issues while ECT is.
Dissociation is one of the side effects of intravenous ketamine, but according to Dr. Anand, patients “do not typically find this to be an unpleasant experience.”
Though those earlier studies mainly examined the two therapies separately, they did demonstrate both treatments can be helpful in patients with difficult to treat depression. Unconnected to the study, Dr. Roger S. McIntyre dubbed it “groundbreaking.”
Dr. McIntyre explained that “It’s this type of rigorous, randomized, real-world pragmatic data that is robust and very clinically meaningful.”
To 365 individuals, the researchers randomly allocated intravenous ketamine or ECT.
The remaining patients had ECT 3 times per week, whereas the majority received ketamine twice per week.
By the end, 55 percent of patients receiving ketamine and 41 percent of patients receiving ECT said symptoms had been reduced by 50 percent or more.
The quality of life ratings was comparable between the two groups 6 months later.
According to Dr. Daniel F. Maixner, who was not involved in the study, one drawback of the research was that because the treatment duration was just 3 weeks, the number of ECT sessions may not have been adequate.
He said that, in contrast to the 9 sessions employed in the study, the ECT patients involved in the study began their treatment by getting electric currents on one side of the brain.
Dr. Maixner stressed that “If there’s more improvement to be had, you continue.”
Patients who begin bilaterally at first, stimulating both sides simultaneously, frequently require fewer sessions.
A bigger percentage of the patients could have reacted to the treatment if they had finished more ECT treatments, according to Dr. Anand, but it would also have probably resulted in more adverse effects.
Under 33 percent of patients in both groups entered remission, indicating they experienced only minor depression symptoms.
This implies that more therapies would be required for the patients to continue experiencing any alleviation.
However, extra dangers are associated with continued therapy.
Dr. Robert Freedman stated in an editorial that was published alongside the paper that lengthier therapy with ketamine, for instance, “increases the chance of both drug dependency and cognitive adverse effects, including dissociation, paranoia, and other psychotic symptoms.”
However, these studies could have included a greater proportion of patients with psychotic depression, for whom ECT appears particularly helpful.
Previous research indicated that ECT remission rates could be significantly higher — frequently at least 60 percent.
Because the FDA has not authorized intravenous ketamine as a treatment for mood disorders, unlike esketamine, better known as Spravato, researchers and doctors are utilizing it off-label.
For treatment resistant depression, intravenous ketamine is frequently regarded by physicians as being as effective as or even more successful than esketamine, according to Dr. Anand.
But due to the fact that intravenous ketamine is a generic medicine, unfortunately, the expert noted that “it is unlikely that anyone is going to try to get F.D.A. approval for it to make it more reimbursable for insurers.”
Dr. Anand and his associates will soon begin taking enrollments for a bigger trial that will enroll 1,500 severely suicidal and depressed patients, most of whom are expected to be inpatients, and compare the effectiveness of ECT and intravenous ketamine.
The impact on different age groups will also be examined, according to Dr. Anand.
According to the study, intravenous ketamine, which Dr. Maixner has previously used to treat patients, may have some newly emerging and significant advantages for difficult to treat depression, which “gives individuals alternatives.”
