A recent study has found that outpatients with moderately severe to severe treatment-resistant depression exhibited greater improvement when treated with ketamine compared to those receiving electroconvulsive therapy.
This finding emerged from a secondary analysis of the randomized clinical trial which assessed the efficacy of these treatments in 365 adults with nonpsychotic treatment-resistant depression (TRD). The study, published in JAMA Network Open, also explored how baseline clinical characteristics influenced treatment outcomes.
Key Findings:
- Patient Population: Among participants exhibiting moderately severe to severe depression, outpatients experienced more pronounced improvements with ketamine treatment. Conversely, inpatients with very severe depression demonstrated significant early responses to electroconvulsive therapy (ECT) although outcomes converged by the end of the treatment period.
- Depression Severity: Patients with baseline 16-item Quick Inventory of Depressive Symptomatology Self-Report scores of 20 or lower (indicating moderate to severe depression) showed greater symptom reduction with ketamine. Those with scores above 20 (indicating very severe depression) initially responded better to ECT.
- Treatment Setting: Outpatients benefited more substantially from ketamine in terms of symptom reduction, whereas inpatients had more significant early responses to ECT.
- Premorbid Intelligence and Comorbidities: Higher premorbid intelligence and the presence of comorbid posttraumatic stress disorder were associated with improved outcomes following ECT.
The secondary analysis was conducted from May 10 to October 31, 2023, at five U.S. academic centers. The participants, aged 21 to 75 years with nonpsychotic TRD, were randomized to receive either six ketamine infusions or nine ECT sessions over three weeks.
For full disclosures, refer to the original study.