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Meta-Analysis
. 2023 Jun 1;80(6):639-642.
doi: 10.1001/jamapsychiatry.2023.0562.

Ketamine vs Electroconvulsive Therapy for Major Depressive Episode: A Systematic Review and Meta-analysis

Vikas Menon  1 , Natarajan Varadharajan  2 , Abdul Faheem  1 , Chittaranjan Andrade  3
Affiliations
Meta-Analysis

Ketamine vs Electroconvulsive Therapy for Major Depressive Episode: A Systematic Review and Meta-analysis

Vikas Menon et al. JAMA Psychiatry. .

Erratum in

  • Errors in Figures.
    [No authors listed] [No authors listed] JAMA Psychiatry. 2023 Jun 1;80(6):651. doi: 10.1001/jamapsychiatry.2023.1752. JAMA Psychiatry. 2023. PMID: 37284883 Free PMC article. No abstract available.

Abstract

Importance: The relative efficacy of ketamine and electroconvulsive therapy (ECT) in adults with major depressive episode (MDE) needs clarification.

Objective: To compare depression rating outcomes with ketamine vs ECT in adults with MDE and to compare response and remission rates, number of sessions to response and remission, and adverse effects.

Data sources: Two investigators independently systematically searched MEDLINE, ScienceDirect, and Google Scholar databases using a combination of relevant Medical Subject Headings terms and free-text keywords from database inception through May 15, 2022, to identify relevant English-language trials.

Study selection: Parallel-group randomized clinical trials (RCTs).

Data extraction and synthesis: Two investigators independently extracted data and assessed risk of bias. One-week posttreatment outcomes were pooled as standardized mean difference (SMD; Hedges g) for continuous outcomes and risk ratio (RR) for categorical outcomes in random-effects meta-analyses.

Main outcomes and measures: Efficacy outcomes were 1-week (or nearest) posttreatment depression ratings, 1-week (or nearest) study-defined response and remission rates, and number of sessions to treatment response and remission. Safety outcomes were reported adverse effects.

Results: Five trials (ketamine group: n = 141; ECT group: n = 137) were meta-analyzed. The overall pooled SMD for posttreatment depression ratings was -0.39 (95% CI, -0.81 to 0.02; I2 = 45%; 5 RCTs). For this efficacy outcome, in a sensitivity analysis of methodologically stronger trials, ECT was superior to ketamine (SMD, -0.45; 95% CI, -0.75 to -0.14; I2 = 6%; 2 RCTs). ECT was also superior to ketamine for study-defined response (RR, 1.27; 95% CI, 1.06-1.53; I2 = 0%; 3 RCTs) and remission (RR, 1.43; 95% CI, 1.12-1.82; I2 = 0%; 2 RCTs) rates. No significant differences were noted between groups for number of sessions to response and remission and for cognitive outcomes. Key limitations were small number of studies, limited sample size, and high risk of bias in all trials.

Conclusion and relevance: The findings of this systematic review and meta-analysis suggest an efficacy advantage for ECT over ketamine in adults with MDE. These conclusions are tempered by the small number and size of existing trials.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Menon reports traveling to deliver guest lectures and conduct workshops, funded by the organizers of the programs in the cities in which they were conducted. Dr Andrade reports publishing an e-newsletter supported by Sun Pharmaceuticals (payments are made directly to registered charities); previously publishing print newsletters for free distribution as an educational service to medical professionals in India, for which production costs were reimbursed by the pharmaceutical organizations responsible for the distribution: Sun Pharmaceutical Industries and Intas Pharmaceuticals; traveling to deliver guest lectures and conduct workshops, funded by the organizers of the programs in the cities in which they were conducted; consulting for Sun Pharmaceutical Industries and Intas Pharmaceuticals for nominal compensation in the form of academic support towards slide preparation or purchase of materials such as textbooks or directly to charities; receiving payments for developing educational materials for scientific initiatives and programs, such as for Behavioral and Neurosciences Foundation of India, PsyBase India, Texas Tech University, Nordic Association for Convulsive Therapy, and American Society of Clinical Psychopharmacology. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. PRISMA Flowchart
ECT indicates electroconvulsive therapy; RCT, randomized clinical trial.
Figure 2.
Figure 2.. Posttreatment Depression Scores for Electroconvulsive Therapy (ECT) vs Ketamine in Patients With Major Depressive Episode: Main Analysis,,,,
IV indicates inverse variance; SMD, standardized mean difference.
Figure 3.
Figure 3.. Posttreatment Depression Scores for Electroconvulsive Therapy (ECT) vs Ketamine in Patients With Major Depressive Episode: Sensitivity Analysis Excluding Methodologically Weaker Trials,
IV indicates inverse variance; SMD, standardized mean difference.
See this image and copyright information in PMC

References

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