JAMA network open

Ketamine compared to electroconvulsive therapy for hard-to-treat depression: A follow-up analysis of a clinical trial

Updated

Abstract

Among 365 participants, intravenous ketamine showed greater improvement in depression for outpatients with moderately severe or severe depression compared to ECT.

  • Participants with a baseline depression score of 20 or less reported a greater reduction in symptoms with ketamine than with ECT.
  • Outpatients experienced a higher decrease in depression levels with ketamine compared to those receiving ECT.
  • Inpatients with very severe depression had a quicker response to ECT, but both treatments resulted in similar depression scores by the end of the study.
  • Higher premorbid intelligence and a diagnosis of posttraumatic stress disorder were linked to greater symptom reduction in ECT recipients.
  • Impaired memory recall in ECT participants led to a larger decrease in depression scores during the second week of treatment.

Simplified

Full Text

We can’t show the full text here under this license.

Funding

Competing interests

Conflict of Interest Disclosures: Dr Jha reported receiving grants from Janssen Research & Development, Neurocrine Biosciences, Navitor/Supernus, and Acadia Pharmaceuticals and personal fees from the Psychiatry & Behavioral Health Learning Network, Elsevier, Eleusis Therapeutics, Janssen Global Services, Janssen Scientific Affairs, Boehringer Ingelheim, Guidepoint Global, Worldwide Clinical Trials, Vicore Pharma, IQVIA, North American Center for Continuing Medical Education, Medscape/WebMD, Clinical Care Options, Global Medical Education, and H.C. Wainwright & Co., LLC, outside the submitted work. Dr Wilkinson reported receiving grants from Janssen and Oui Therapeutics and personal fees from Janssen and Sage Therapeutics outside the submitted work. Dr Collins reported receiving grants from the Patient-Centered Outcomes Research Institute during the conduct of the study and receiving personal fees from Relmada Therapeutics, Inc, Cronos Clinical Consulting Services, Inc, MedAvante-ProPhase, A. Stein- Regulatory Affairs Consulting, Ltd, and the University of Texas Southwestern outside the submitted work. Dr Sanacora reported receiving personal fees from AbbVie, Atai, Biogen, Biohaven Pharmaceuticals, Boehringer Ingelheim International GmbH, Bristol Myers Squibb, Clexio, Denovo Biopharma, ECR1, EMA Wellness, Embark, Daiichi Sankyo, Freedom Biosciences, Gilgamesh, Janssen, Merck, Neurocrine, Novartis, Perception Neuroscience, Relmada Therapeutics, Sage Pharmaceuticals, Seelos Pharmaceuticals, Tetricus, Transcend Therapeutics, the Usona Institute, and XW Laboratories; equity from Biohaven Pharmaceuticals, Freedom Biosciences, Relmada Therapeutics, and Tetricus; and grants from Janssen, Merck, and the Usona Institute outside the submitted work and reported having a patent licensed to Biohaven and to Freedom Biosciences as a coinventor on a US patent and reported that Yale University (employer) has a financial relationship with Janssen Pharmaceuticals and may receive financial benefits from this relationship but reported receiving no direct payments through this relationship because Yale University has put multiple measures in place to mitigate this institutional conflict of interest. Dr Murrough reported receiving personal fees from LivaNova, Biohaven, Clexio Biosciences, Merck, and Xenon Pharmaceuticals outside the submitted work and reported that the Icahn School of Medicine at Mount Sinai (employer) is named on a patent and has entered into a licensing agreement and will receive payments related to the use of ketamine or esketamine for the treatment of depression and is named on a patent related to the use of ketamine for the treatment of posttraumatic stress disorder; Dr Murrough is not named on these patents and will not receive any payments. Dr Barnett reported receiving personal fees from Compass Pathways, Cerebral, Dynamed, and Janssen Pharmaceuticals and receiving grants from MindMed and Compass Pathways outside the submitted work. Dr Costi reported receiving personal fees from Guidepoint and TCG Crossover outside the submitted work and having US patents and several pending US patent applications related to ketamine and esketamine for treatment-resistant depression, suicidal ideation, and other disorders from the Icahn School of Medicine at Mount Sinai, which has entered into a licensing agreement with Janssen Pharmaceuticals, Inc, and has received and will receive payments from Janssen under the license agreement related to these patents during the conduct of the study. Dr Malone reported receiving grants from the Cleveland Clinic Patient-Centered Outcomes Research Institute (PCORI) during the conduct of the study. Dr Hu reported receiving grants from PCORI during the conduct of the study. Dr Mathew reported receiving grants from PCORI during the conduct of the study and receiving personal fees from Abbott, Almatica, Biohaven, BioXCel, Boehringer-Ingelheim, Brii Biosciences, Clexio Biosciences, Compass Pathways, Delix Therapeutics, Douglas Pharmaceuticals, Freedom Biosciences, Liva Nova, Levo Therapeutics, Merck, Motif Neurotech, Neumora, Neurocrine, Perception Neurosciences, Praxis Precision Medicines, Relmada Therapeutics, Sage Therapeutics, Seelos Therapeutics, Signant Health, Sunovion, Xenon Pharmaceuticals, Worldwide Clinical Trials, and XW Pharma and receiving grants from Engrail Therapeutics outside the submitted work. No other disclosures were reported.
PubMed

What Lands in Your Inbox Each Week:

  • 📚7 fresh studies
  • 📝plain-language summaries
  • direct links to original studies
  • 🏅top journal indicators
  • 📅weekly delivery
  • 🧘‍♂️always free