ECT appears to have a small advantage over ketamine for improving depressive symptoms in adults with a major depressive episode, results of a new review show.
In the main analysis, posttreatment depression ratings showed a trend for lower scores with ECT compared with ketamine .
"There is a need for more comparative studies with adequate sample size in non-inferiority designs, examining a wider range of benefits and side effects, and followed up for longer durations, to answer clinically relevant questions about the nature and durability of observed benefits with ketamine," said Menon.
"Whether or not there is a difference depends on exactly how you define it and how you cut the data. Despite the slight advantage for ECT in this analysis, the authors support using ketamine before ECT, especially in patients who are worried about the cognitive risks of ECT. This seems sensible," McShane said.
"There is evidence that ketamine with ECT may add little extra benefit but much more work needs to be done to fully understand how these treatments fit best into the treatment pathway for major depressive episodes. However, based on this evidence, ECT clearly still merits a place in the treatment pathway," Young added.
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