Citation

Ekstrand J, Fattah C, Persson M, Cheng T, Nordanskog P, Åkeson J, Tingström A, Lindström MB, Nordenskjöld A, Movahed Rad P. Int. J. Neuropsychopharmacol. 2022; 25(5): 339-349.

Copyright

(Copyright © 2022, Cambridge University Press)

DOI

10.1093/ijnp/pyab088

PMID

unavailable

Abstract

BACKGROUND: Ketamine has emerged as a fast-acting and powerful antidepressant, but no head to head trial has been performed, Here, ketamine is compared with electroconvulsive therapy (ECT), the most effective therapy for depression.

METHODS: Hospitalized patients with unipolar depression were randomized (1:1) to thrice-weekly racemic ketamine (0.5 mg/kg) infusions or ECT in a parallel, open-label, non-inferiority study. The primary outcome was remission (Montgomery Åsberg Depression Rating Scale score ≤10). Secondary outcomes included adverse events (AEs), time to remission, and relapse. Treatment sessions (maximum of 12) were administered until remission or maximal effect was achieved. Remitters were followed for 12 months after the final treatment session.

RESULTS: In total 186 inpatients were included and received treatment. Among patients receiving ECT, 63% remitted compared with 46% receiving ketamine infusions (P =. 026; difference 95% CI 2%, 30%). Both ketamine and ECT required a median of 6 treatment sessions to induce remission. Distinct AEs were associated with each treatment. Serious and long-lasting AEs, including cases of persisting amnesia, were more common with ECT, while treatment-emergent AEs led to more dropouts in the ketamine group. Among remitters, 70% and 63%, with 57 and 61 median days in remission, relapsed within 12 months in the ketamine and ECT groups, respectively (P =. 52).

CONCLUSION: Remission and cumulative symptom reduction following multiple racemic ketamine infusions in severely ill patients (age 18-85 years) in an authentic clinical setting suggest that ketamine, despite being inferior to ECT, can be a safe and valuable tool in treating unipolar depression. © 2021 The Author(s). Published by Oxford University Press on behalf of CINP.

Language: en

Keywords

adult; human; suicide; female; male; aged; alcoholism; bipolar disorder; abdominal pain; ketamine; depression; schizophrenia; randomized controlled trial; major depressive disorder; suicide attempt; major depression; Brief Psychiatric Rating Scale; Electroconvulsive therapy; dissociative disorder; mood disorder; emotional disorder; fatigue; major clinical study; vomiting; controlled study; expectation; antidepressant agent; anxiolytic agent; neuroleptic agent; tachycardia; xerostomia; automutilation; fear; medical record; headache; vertigo; paranoia; anxiety disorder; groups by age; sleep disorder; panic; myoclonus; urine retention; constipation; electroconvulsive therapy; psychopharmacotherapy; treatment withdrawal; confusion; drug safety; family history; hospital patient; treatment refusal; seizure; follow up; diarrhea; nausea; hypotension; catatonia; muscle hypertonia; relapse; side effect; hypnotic agent; depressive psychosis; amnesia; infection; myalgia; tinnitus; skin irritation; muscle relaxant agent; DSM-IV; remission; visual analog scale; obsessive compulsive disorder; anesthesia; paresthesia; hypoxia; bradycardia; bronchospasm; central stimulant agent; diplopia; drug infusion; mood stabilizer; euphoria; thrombosis; Montgomery Asberg Depression Rating Scale; deep vein thrombosis; Article; outcome assessment; treatment duration; post hoc analysis; blurred vision; sore throat; salivation disorder; larynx spasm; swelling; comparative effectiveness; antidepressant activity; intention to treat analysis; adverse event; patient dropout; fasting; psychological care; ketamine infusion; non-inferiority trial; psychotic depression; racemic ketamine