Comparative Efficacy and Safety of Ketamine Versus Electroconvulsive Therapy in Major Depressive Disorder: A Meta-Analysis of Randomized Controlled Trials.
Zhijian Ma, Fengle Wu, Wen Zheng
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In 30 seconds
This meta-analysis pooled randomized controlled trials comparing ketamine with electroconvulsive therapy (ECT) in patients with major depressive disorder. Six studies involving 643 patients were included. Depression symptom severity did not differ significantly between treatments (SMD: -0.02, 95% CI: -0.53 to 0.48, P = 0.92), nor did response rates (RR: 1.08, 95% CI: 0.67 to 1.72, P = 0.76). Ketamine was associated with greater improvement in memory function, alongside different adverse-event profiles. The authors describe ketamine as non-inferior, while noting that the limited evidence base requires confirmation in larger trials.
Key findings
- Symptom severity scores showed no significant difference between ketamine and ECT (SMD: -0.02, 95% CI: -0.53 to 0.48, P = 0.92).
- Response rates did not differ significantly (RR: 1.08, 95% CI: 0.67 to 1.72, P = 0.76).
- Memory function improvement favored ketamine (SMD: 2.02, 95% CI: 1.64 to 2.48, P < 0.001).
- Ketamine was associated with more dissociative symptoms, blurred vision, and dizziness, but less muscle pain (all P < 0.001).
Why it matters
The pooled findings suggest broadly similar symptom and response outcomes for ketamine and ECT, while indicating differences in memory outcomes and adverse effects. These trade-offs may inform clinical discussions about treatment options, but the small number of included studies limits confidence in the comparative estimates.
What to keep in mind
Only six studies were included; the authors call for larger randomized trials using standardized assessment scales to validate the findings.