Ketamine vs. Electroconvulsive Therapy: Which is More Effective for Depression

Electroconvulsive therapy (ECT) is a treatment option for individuals with mental disorders who have not found positive results with traditional methods. Despite its historical association with torture, ECT is now considered safe, painless, and effective for cases of bipolar affective disorder, severe depression, schizophrenia, as well as certain cases of epilepsy and catatonia.

The procedure involves stimulating the brain through electrodes placed on the temples, causing mild seizures that are not painful because the patient is under anesthesia according to medical protocols.

“Antidepressant medications take an average of three to four weeks to take effect. With ECT, you experience improvements in one or two weeks,” explained psychiatrist José Gallucci Neto, coordinator of the electroconvulsive therapy service at IPq (Institute of Psychiatry) of the Hospital das Clínicas at the Faculty of Medicine of USP, to VivaBem UOL. “For catatonia, there is already a significant improvement after the first two or three treatments. It saves lives in the vast majority of cases.”

However, the procedure is not universally accepted among professionals. “It is a mechanism easily associated with situations of violence and human rights violations. Electroconvulsive therapy devices end up being used without the proper professional prescription. It is a device that should have stricter control,” stated psychiatrist Paulo Amarante, coordinator of LAPS/ENSP/Fiocruz (Laboratory of Psychosocial Attention of the Sergio Arouca National School of Public Health) to UOL.

Alternative to shock

In addition to the lack of technical control and accessibility issues, researchers are seeking other treatment methods that are equally effective as ECT.

“In this context, ketamine (…) is gaining credibility as a relatively safe, effective, and fast-acting antidepressant. Over the past 10 years, several randomized clinical trials have compared the efficacy of ketamine and ECT in patients with major depressive episodes,” wrote researchers Vikas Menon, Natarajan Varadharajan, and Abdul Faheem in a study published in April 2023 in the Journal of the American Medical Association (JAMA), one of the world’s leading medical publications.

To perform a comparative analysis of the effectiveness of ECT and ketamine, the researchers conducted a review of publications from databases including MEDLINE, ScienceDirect, and Google Scholar.

During the analysis, Menon and his team encountered some limitations, such as a small number of eligible studies, as well as studies with small samples and low methodological quality with high risks of bias. For example, no study examined retrograde amnesic deficits, which is the most problematic adverse effect of ECT.

Therefore, the researchers concluded that “The results of this study suggest that ECT may be superior to ketamine in improving depressive symptoms in adults with major depression. However, the advantage is small, and therefore, for many patients, especially those who wish to be protected against cognitive risks, it may be worth considering a ketamine trial before an ECT trial.”

It is important to remember that both ECT and ketamine are recommended in cases where conventional antidepressants have already been used as the first option. Additionally, in both treatments, medical supervision is essential. Nevertheless, the limitation of existing studies reinforces the idea that more research on the subject needs to be conducted for greater accuracy in the results.

To learn more about the systematic review published in JAMA, access the full study.

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