Considering different options to find relief from treatment-resistant depression (TRD)? When it comes to TRD, a condition that affects up to one in three adults with major depressive disorder, both ketamine and electroconvulsive therapy (ECT) are well-established methods. Though ECT is the standard practice for treating severe depression, its side effects make it controversial. Let’s take a look at how each treatment works, what the experience is like for the patient, and compare their efficacy and safety based on current evidence.
Understanding Electroconvulsive Therapy
Electroconvulsive therapy (ECT) involves administering a mild electrical current to the brain to induce a brief seizure. The procedure, conducted under general anesthesia, is typically used to treat severe mental health conditions including major depressive disorder, schizophrenia, and bipolar disorder.
How ECT Works
Electrodes are placed on the patient’s scalp and a controlled electrical current is very briefly passed through the brain, inducing a seizure that lasts about 30 to 90 seconds. The entire procedure, including preparation and recovery, takes about an hour with patients typically undergoing multiple sessions over several weeks.
Pros of ECT
- Effectiveness: ECT is highly effective, particularly for severe depression and catatonia. It can provide lasting relief when other treatments have failed.
- Speed of Response: Patients often experience significant improvements within three to five treatments.
- Safety: Modern ECT is safe and the use of anesthesia and muscle relaxants minimizes discomfort and risk.
Combination with - Medication: ECT can be effectively combined with pharmacotherapy to enhance treatment outcomes.
- Costs: ECT is usually covered by insurance.
Cons of ECT
- Memory Loss: Temporary memory loss and confusion are common side effects, with a small risk of permanent memory issues.
- Medically-Intensive: ECT requires anesthesia and a team of specialized healthcare providers.
Maintenance - Treatments: Some patients may need ongoing maintenance sessions to sustain the benefits.
- Social Stigma: Because of distorted portrayals in film and television, ECT often carries a stigma.
Understanding Ketamine Treatment
Ketamine, originally used as an anesthetic, has gained attention for its rapid antidepressant effects. In clinical settings for the treatment of mood disorders, it is administered in low doses and works by modulating neurotransmitter activity in the brain. It can be administered intravenously or, alternatively, a ketamine-derivative called esketamine (Spravato) can be administered through an easy-to-use nasal spray that has also been proven safe and effective. Numerous studies have found that ketamine is well-tolerated and provides significant relief for patients with severe mood disorders, and it’s become a well-established treatment method. While IV ketamine as treatment for depression is off-label, esketamine (Spravato) for treatment-resistant depression is FDA-approved and therefore typically covered by insurance.
Procedure Details
For IV ketamine, a typical protocol involves a series of infusions administered over a period of weeks. Each session lasts about 40 minutes, during which the patient is monitored for side effects. The nasal-spray option (Spravato) may be more comfortable for some patients and also requires a series of treatment sessions under clinical supervision.
Pros of Ketamine
- Rapid Relief: Ketamine can produce antidepressant effects within hours to days, providing quick relief for those with severe symptoms.
- Effectiveness: Studies, such as one conducted at Yale Psychiatric Hospital, have shown that IV ketamine can be very effective for patients with treatment-resistant mood disorders. Spravato has also shown proven efficacy and is FDA approved for treatment resistant depression.
- Safety Profile: When administered in a controlled clinical setting, ketamine is generally well-tolerated with manageable side effects.
Cons of Ketamine
- Duration of Effects: The antidepressant effects of ketamine can require maintenance sessions for sustained benefit.
- Side Effects: Common side effects include temporary dissociation, dizziness, nausea and transient increase in blood pressure.
- Long-Term Research: The long-term safety of IV ketamine for depression is not fully established yet.
Comparing Efficacy and Safety: Clinical Trials
One recent clinical trial involving 365 adults concluded that intravenous ketamine showed greater improvement among patients with nonpsychotic TRD as compared to electroconvulsive therapy. Another study published in the New England Journal of Medicine found that 55% of those receiving ketamine and 41% of those receiving ECT had at least a 50% improvement in their self-reported depressive symptoms and an improvement in their self-reported quality of life that lasted throughout the six-month monitoring period. But while ECT treatment was associated with memory loss and adverse musculoskeletal effects, ketamine treatment had no side effects other than an experience of dissociation at the time of treatment.
Ketamine vs. ECT for Depression
For many patients, ketamine offers a less invasive and faster-acting alternative to ECT. Its ability to provide rapid relief from depressive symptoms can be crucial for individuals in acute distress. Additionally, the administration of ketamine does not require the extensive medical team and anesthesia associated with ECT, making it more accessible in various healthcare settings and a more attractive option for many patients.
However, the choice between ketamine and ECT should be individualized, considering the patient’s specific condition, treatment history, and personal preferences. Both treatments have their place in helping patients manage TRD, and ongoing research continues to refine their use and optimize outcomes for patients.
KETA Medical Center specializes in esketamine (Spravato) and IV Ketamine treatments for a wide range of conditions. If you want to learn more, feel free to contact us for a free consultation!