Research Review: Ketamine vs ECT for Treatment-Resistant Depression: New Insights from the ELEKT-D Trial
A recent analysis shows that ECT and ketamine are both effective long-term, with moderate to severe depression patients having faster improvement with ketamine, and very severe depression responding faster to ECT.
As a holistic mental health and pain clinic, NeuroPain Health is always eager to share the latest research on treatment options for depression, especially when it comes to comparing ketamine with other established therapies.
Today, Dr. Weiner explores a recently published secondary analysis of the ELEKT-D trial, which compared ketamine to electroconvulsive therapy (ECT) for treatment-resistant depression.
What was the ELEKT-D trial?
The ELEKT-D trial was a large, multi-center study conducted at five US academic medical centers. It compared the effectiveness of intravenous ketamine to ECT in treating adults with treatment-resistant depression (TRD). The original study found that ketamine was non-inferior to ECT in treating TRD..
What did this new analysis of the trial look at?
This secondary analysis aimed to identify which patients might benefit more from ketamine versus ECT. The researchers looked at various factors such as:
Depression severity
Outpatient vs. inpatient status
Cognitive function
History of suicide attempts
Treatment Outcomes of Ketamine vs Electroconvulsive Therapy (ECT) Stratified by Less or More Severe Baseline Depression Severity.
Diagram via JAMA
How was the ELEKT-D study conducted?
The researchers designed a comprehensive study to compare the effectiveness of ketamine and ECT in treating treatment-resistant depression. They carefully structured the trial to ensure a fair comparison and to gather detailed data on participants' responses to each treatment. Here's a breakdown of the study design:
365 adults with TRD were included
Participants were randomly assigned to receive either:
6 ketamine infusions over 3 weeks
9 ECT treatments over 3 weeks
Depression symptoms were measured using self-report (QIDS-SR16) and clinician-rated (MADRS) scales
Researchers analyzed how different factors affected treatment outcomes
What were the key findings?
The study revealed some intriguing differences in how patients responded to ketamine versus ECT, depending on their initial depression severity and treatment setting. These findings could help guide treatment decisions for individuals with treatment-resistant depression:
Outpatients with moderately severe or severe depression showed greater improvement with ketamine compared to ECT
Inpatients with very severe depression initially improved more with ECT
By the end of treatment, both groups had similar improvements
Of note: Patients with higher premorbid intelligence showed greater improvement with ECT.
What does this mean for patients?
These findings offer valuable insights that could help patients and their healthcare providers make more informed decisions about treatment options. The results suggest that the most effective treatment may depend on individual factors such as depression severity and treatment setting:
If you have moderately severe to severe depression and are being treated as an outpatient, ketamine might be a better option for you than ECT.
If you have very severe depression and require inpatient treatment, ECT might work faster initially, but both treatments could be equally effective by the end of three weeks.
For those considering ECT, having higher cognitive function or some memory impairment doesn't rule out its effectiveness - in fact, it might even predict better outcomes in some cases.
Limitations to Keep in Mind
It's important to note that this was a secondary analysis, meaning these findings weren't the primary focus of the original study. While intriguing, they should be considered preliminary and need further research to confirm.
This study provides valuable insights that can help guide treatment decisions for people with treatment-resistant depression. It suggests that outpatients with moderately severe to severe depression might want to consider ketamine as a first-line option before ECT.
However, every patient is unique, and treatment decisions should always be made in consultation with a qualified healthcare provider. At our clinic, we're committed to helping each patient find the most effective treatment path, whether that includes ketamine, other therapies, or a combination approach.
Remember, if you're struggling with depression, there are effective treatments available. Don't hesitate to reach out for help and explore your options - contact us today.