- Major depression is a serious mental illness that can cause emotional and physical symptoms as well decrease in quality of life.
- Researchers are still trying to figure out the best ways to treat drug-resistant depression.
- A new study has found that ketamine infusion is comparable to electroconvulsive therapy in the treatment of major depressive disorder.
Depression is a common mental illness. People often respond to treatments that combine medication and therapy, but some forms of depression are resistant to typical techniques.
Experts are still trying to figure out how to help people with treatment-resistant major depression.
A recent study published in The New England journal of medicine compared the use of ketamine infusions with electroconvulsive therapy (ECT) two interventions for treatment-resistant major depression.
Researchers have found that the use of ketamine can be as effective as electroconvulsive therapy in helping people with treatment-resistant depression, with little or no side effects.
Study author Dr. Amit Anand, director of translational clinical trials in psychiatry at Mass General Brigham, said Medical News Today:
The study objective was to investigate whether intravenous subanesthetic ketamine was nearly as effective as ECT for treatment-resistant depression. The results were a little surprising as ketamine did even better than that. Ketamine is a good alternative for patients who have been referred for ECT for the treatment of their resistant depression.
This study was an open-label, randomized, non-inferiority study. The researchers recruited participants who suffered from treatment-resistant major depression. All participants had undergone electroconvulsive therapy.
The researchers divided the participants into two groups. One group had 195 participants and received intravenous infusions of ketamine twice a week for three weeks. The other group had 170 participants and received electroconvulsive therapy three times a week for three weeks.
They assessed treatment responses in both groups based on self-reports using a specific scoring method.
A higher score indicated worse depression. They defined a treatment response as a score that decreased by at least 50%. The researchers then followed up for over six months with the participants who experienced a response.
Both groups experienced an improvement in depressive symptoms. About 55% of participants in the ketamine group saw improvement, and about 41% of participants in the ECT group saw improvement.
Overall, the ketamine intervention group had fewer problems with memory recall after the three weeks of treatment. The results indicate that ketamine is non-inferior to electroconvulsive therapy.
Dr. David Feifel, PhD, neuropsychiatrist and director of Kadima Neuropsychiatry Institute, who was not involved in the study, noted a MNT extension:
The finding that six sessions of ketamine was no less effective than nine sessions of ECT, and produced milder side effects than ECT, has huge implications for guiding what treatment should be recommended when patients fail to improve with ketamine treatments. first line.
- empty
- loss of enjoyment in activities
- suicidal thoughts
People with depression may feel less motivated to complete work tasks or other responsibilities. They may also find it difficult to maintain their relationships, which could be daunting for everyone involved.
If someone hasn’t responded to two or more medications to treat depression, doctors can diagnose them with treatment-resistant major depression.
Dr. Feifel explained to MNT extension:
ECT is usually used as a last resort treatment for the treatment of DCS [major depressive disorder] because it is considered the most effective treatment for this condition, but it is also associated with the highest rate of side effects, such as memory problems, which in some people can persist well after ECT treatments have finished.
Dr. Feifel added that psychiatrists and medical professionals had been skeptical of ketamine’s efficacy and safety. Some, he said, opposed treating major depressive disorder with ketamine.
As more research validates the use and safety of ketamine for therapeutic purposes, the stigma surrounding the drug may eventually fade.
This study will undoubtedly play an important role in promoting the acceptance of ketamines among skeptics. Much more research is still needed, for example, to identify which patients are more likely to benefit from ECT and which from ketamine.
Dr. David Feifel, neurobiologist and psychiatrist
The study had key limitations. First, data collection on depression relies on self-reporting of depressive symptoms, making generalization of findings more difficult. Second, it included only a small sample size with a short follow-up period.
Researchers acknowledge that electroconvulsive therapy can have more profound effects in certain situations, such as in the hospitalization setting. It is also possible that ECT could have been more effective in this study if participants had received more sessions or used a bilateral placement method as a starting point.
But these interventions may also have increased the risk of adverse events. There was a certain level of flexibility in treatment methods in this study and this flexibility may have limited results.
The researchers were also limited by the type of study method they used. Factors such as that it was an open-label study, that it didn’t have a placebo, and that they hadn’t studied maintenance therapy could have influenced the results.
Regardless, the study lends further credence to the use of ketamine in situations of severe depression.
More research is needed in more specific populations such as the elderly and bipolar depression, as well as in urgent situations such as the treatment of depression associated with acute suicidality (we are now initiating such a study). Also, new drugs must be developed that can work like ketamine but do not have its associated side effects or possible addiction potential.
Dr. Amit Anand, psychiatrist and author of the study
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