Key messages
With a meta-analysis of 5 randomized trials with a total of less than 300 participants, researchers have found that electroconvulsive therapy tends to be more effective at combating major depression, and also achieves higher response rates and more remissions than ketamine.
Background
Both the narcotic ketamine and electroconvulsive therapy (ECT) are among the relatively rarely used therapeutic options for adults with episodes of major depressive disorder (MDE).The relative effectiveness of the two methods must be clarified, the authors of the current paper demand.
Design
Systematic review and meta-analysis comparing ketamine and ECT with regard to therapy outcomes in the form of depression assessment one week after treatment, as well as response and remission rates. The literature databases MEDLINE, ScienceDirect and Google Scholar were searched for randomized clinical trials in parallel group design.
Results
- The inclusion criteria were met in 5 studies in which 141 patients received ketamine and 137 received ECT. The improvements were calculated in the form of the standardized mean difference (SMD) for all study participants with a score of – 0.39 (95% confidence interval – 0.81 to 0.02).
- In a sensitivity analysis of the methologically stronger studies, ECT was superior to ketamine (SMD – 0.45; 95% CI – 0.75 to – 0.14).
- ECT was also better in terms of response as defined in the respective studies (n = 3).Here, the odds ratio was RR 1.27 with a 95% CI of 1.06 – 1.53.
- The remissions recorded in 2 studies were also more common with ECT than with ketamine (RR 1.43; 95% CI 1.12 – 1.82).
- The researchers found no significant differences in the number of sessions needed to achieve remission, nor in cognitive outcomes.
Clinical significance
With only 5 studies and less than 300 patients, the significance of this meta-analysis is likely to be limited. This is also acknowledged by the authors.
Funding: N/A.
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Source — https://www.univadis.de/viewarticle/mini-meta-analyse-vergleicht-elektrokrampftherapie-mit-2023a10009wr