A new study For some patients, the anesthetic Ketin is an alternative to electroconvulsive therapy or ECT, which is currently the fastest and most effective option for patients with depression. The study is the largest head-to-head comparison of the two treatments.
Patients who do not respond to at least two antidepressants – In Care Of one third Patients with clinical depression – have what clinicians call “treatment-resistant” illness. Their options for relief are limited. Doctors typically recommend up to 12 ECT sessions, which include a Proven effectiveness for a long timebut it is tainted with hatred. Historical abuse And scary Hollywood images People strapped to a table, writhing in pain. Today’s ECT is safer and uses general anesthesia, but the procedure is rarely used.
The study, published on Wednesday in the New England Journal of Medicine, found that when administered intravenously, ketamine was at least as effective as ECT in treatment-resistant depression and nonpsychiatric patients. (For people with psychosis, ketamine, even in very low doses, can worsen psychosis-like symptoms.)
“The results were surprising to us,” said study leader Dr. Amit Anand, a professor of psychiatry at Harvard Medical School who studies mood disorders at Massey General Brigham. His team initially hypothesized that ketamine would be as effective as ECT. Instead, says Dr. Anand, ketamine performed better than that.
This is important in part because some patients are uncomfortable with the side effects of ECT, such as temporary memory loss, muscle pain, or weakness. (It can occasionally cause permanent gaps in memory.)
Dr. Anand said the study, sponsored by the Cleveland Clinic Foundation, showed that KT was easier to administer, with fewer adjustments during treatment and fewer patients dropping out. “More importantly, ECT, as expected, shows that it is associated with memory problems, but not ketamine.” Intravenous ketamine also has side effects such as withdrawal, but this is “mostly not an unpleasant experience for patients,” said Dr. Anand.
Previous studies have shown that both treatments can be effective in patients with difficult-to-treat depression, but research has primarily looked at the two treatments separately. Dr. Roger S. McIntyre, a professor of psychiatry and pharmacology at the University of Toronto, who was not affiliated with the study, called it “groundbreaking.”
“This is the kind of rigorous, randomized, real-world functional data that is robust and very clinically meaningful,” Dr. McIntyre said.
The researchers randomly assigned 365 patients to intravenous ketamine or ECT. About half received ketamine twice a week, while the rest received ECT three times a week. At the end of the three-week treatment, 55 percent of the patients in the ketamine group and 41 percent of the patients in the ECT group reported a reduction of 50 percent or more in symptoms.
After six months, quality of life scores were similar for both groups.
One limitation of the study is that the number of ECT treatments may not have been sufficient because the treatment duration was only three weeks, said Dr. Daniel F., director of the ECT program at the University of Michigan Medicine. Related to the study.
The study subjects began their ACT course by receiving 10 or 12 sessions of electrical current in one part of the brain, as opposed to the nine used in the study, he said.
Dr. Meixner said, “If there is further improvement, they will continue.”
Patients who start bilaterallyStimulate both sides at once, often It needs a few sessions.. If the patients complete more ECT sessions, a greater number may have responded to the treatment, Dr. Anand said, but that can also cause more side effects.
A small number of patients in both groups – less than 33 percent – went into remission, meaning they had only mild depressive symptoms. This indicates that additional treatments are needed for patients to expect any relief.
Continued treatment, however, comes with additional risks. For example, long-term treatment with ketamine “increases both drug dependence and negative cognitive effects of dissociation, paranoia, and other psychotic symptoms,” writes Dr. Robert Friedman, a professor of psychiatry at the University of Colorado. Editorial published with the study.
Previous evidence It has been suggested that ECT remission rates can be very high – often at least 60 percent – but these studies may have included high-risk patients and patients with psychological distress, for whom ECT appears to be most effective.
Researchers and clinicians are using intravenous ketamine off-label because it is not approved by the Food and Drug Administration for mood disorders, unlike its cousin esketamine, which is administered intranasally. Among clinicians, intravenous ketamine is widely considered As effective or more than esketamine for treatment-resistant depression, Dr. Anand said.
Unfortunately, because intravenous ketamine is a generic drug, “nobody seems to be trying to get FDA approval to make it more reimbursable for insurers,” he added.
Later this year, Dr. Anand and his colleagues will recruit 1,500 patients for a large study comparing ECT with intravenous ketamine in 1,500 severely suicidal and depressed patients. They also looked at how the results differed across age groups, Dr. Anand said.
Dr. Meixner, of Michigan Medicine, says research suggests that intravenous ketamine, which he used to treat patients with, “gives people options” has some new and powerful benefits for treating depression.