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Repeated doses of Ketamine > repeated ECT in patients hospitalized with MDD

arctica

arctica

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Dec 15, 2009
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There's a new study out comparing the efficacy of 3 rounds of ketamine infusions vs. 3 rounds of ECT in 18 patients, and ketamine came out on top:

Rapid antidepressant effects of repeated doses of ketamine compared with electroconvulsive therapy in hospitalized patients with major depressive disorder

Here is the blurb from an APA Psychiatric News Alert:

Study Compares Ketamine With ECT in Treatment-Resistant Depression

Evidence has been building over the last few years to suggest that the anesthetic ketamine can rapidly reverse some cases of treatment-resistant depression. In light of those data, Mehdi Ghasemi, M.D., a postdoctoral research fellow in neurology at Johns Hopkins University School of Medicine, and colleagues conducted a pilot study to find out how ketamine compares with electroconvulsive therapy (ECT) in treating depressed patients who have failed on other therapies.

Eighteen hospitalized patients with major depressive disorder were randomized to receive either three infusions of ketamine or three ECT treatments. The primary outcome measures were the Beck Depression Inventory and Hamilton Depression Rating Scale, which were used to rate overall depressive symptoms at baseline and at 24 hours, 72 hours, and one week after treatment. Ketamine was found to have a more rapid onset of antidepressant action as well as more effectiveness in decreasing depression, the researchers reported in Psychiatry Research.

"Studies exploring depression treatments that rival the rapid, definitive treatment response of ECT are important," M. Justin Coffey, M.D., chief of the Consultation-Liaison Psychiatry Services and of the ECT Therapy Service at Henry Ford Behavioral Health Services in Detroit, told Psychiatric News. "[However,] any conclusions drawn from this study are significantly limited by the small sample size and the lack of seizure-monitoring (i.e., using EEG) during the ECT treatments. Moreover, it is not clear that comparing one ketamine infusion to one ECT treatment is valid when the benefits of ECT become manifest typically over a course of treatments."

More information about ketamine and depression can be found in the Psychiatric News article "Ketamine Shows Rapid Action in Treatment-Resistant Depression."
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It seems like ketamine is pretty promising, "compared with the ECT." If anyone has a link to the full article, I would be grateful.
 
I'm a little surprised, ect is generally one of the strongest antidepressant treatments available, for this to beat it is pretty meaningful, especially given that it has far fewer and more mild side effects.
 
Now that we're here in the future, someone should start investigating ketamine "rescue inhalers" for suicidality. I think it would save lives.
 
Trials with Ketamine for the treatment of depression have been ongoing for some time even here in Australia. This evidence of ketamine trumping ECT although more trials of this type would need to be conducted and overall efficacy compared. Seizure monitoring is essential in ECT however as that is the measure of how successful the ECT treatment is meant to be in terms of treating treatment resistant depression.

Thing is the medical community is aware of this and has been for some time but I think there may be more behind the scene so to speak. If ketamine, a cheap and non patent drug, has a better efficacy than ECT and therefore all current drugs used to treat depression imagine the financial loss to companies with medication patents for new generation anti-depressant medication. I am no conspiracy theorist (hell I can barely spell conspiracy) yet there have been a number of trials that show ketamine to be a highly effective anti-depressant that only requires low drug dosages and no prolonged daily use.

Also makes me wonder if my GF has depression or another mental illness when she hates ketamine so much and it does sweet FA for her mood. More like schizotypal personality disorder.
 
I hope we see more trials on using Ketamine for depressive episodes caused by conditions other than MDD in the near future. I know that anecdotally ketamine has been very effective in bipolar patients who are refractory to other treatments, now it's time to see some data.

The majority of the medical community is still very skeptical about the whole topic ("of course they feel better, they're tripping balls!"). I've mentioned the success people have been having with ketamine to some doctors in my area, and by their responses you would think I was encouraging expectant mothers to take up heroin. Hopefully the authors of this trial do a good job publishing their results so more people are aware of what's been happening behind the scenes.
 
I don't understand why the hospitalized patients were Iranian, as the first author apparently hails from JHU. Is it easier to push a trial like this through an IRB in Iran than the U.S.? I assume that it would have needed to go through JHU's IRB as well. From personal experience, I know that there is certainly an adequate supply of depressed and hospitalized patients in Baltimore. Perhaps the difference is that Hopkins doesn't have an official affiliated psychiatric hospital (e.g. McLean for Harvard), even though there is an excellent psychiatric hospital nearby (Sheppard Pratt).
 
If this is true then this could a great leap forward in treating depression/bipolar.
ECT treatments are effective as a last resort but the side effects are awful, I mean my mother sometimes has a hard time remembering stuff she did earlier in the day from her ECT treatments, although her long term memory is phenomenal
 
Artica....great post! I'm new here and don't see a 'like button' so thought I'd thank you personally!

This sounds SO promising for lessening the severe pain of treatment-resistant Major Depression for so many sufferer's....but then again so much has sounded positive only to fail after long years of debilitating yet patient,hopeful waiting.

Over the decades I and countless other's have had our hopes crushed so many times that it's difficult to believe in anything anymore.

Still, I must admit I'm very cautiously optmistic about this research.

Wonder how loooong it will take to trickle down? Probably not until BigPharma and/or AMA figure out a way to exploit this inexpensive med for financial gain.
Hopefully soon enough to help many millions who suffer so greatly. Curing Depressive illness would be world changing in thousands of ways!

All diseases would reap benefits as so many physical illnesses are exacerbated and some even caused by stress/depression related disorders.

Probably won't be available soon enough for me but gives me hope for other's.

Artica, or anyone else who replied, do you know if the improvement was enough to restore fully functioning lives to the patients thus freeing them from taking zombifying meds, allowing independent living, the ability/motivation to attain meaningful work, etc?

Will there be more studies in the near future? If anyone knows of a research study please message me. Thank You.

amyamy
 
amyamy said:
Wonder how loooong it will take to trickle down? Probably not until BigPharma and/or AMA figure out a way to exploit this inexpensive med for financial gain.
Hopefully soon enough to help many millions who suffer so greatly. Curing Depressive illness would be world changing in thousands of ways!

All diseases would reap benefits as so many physical illnesses are exacerbated and some even caused by stress/depression related disorders.

Probably won't be available soon enough for me but gives me hope for other's.

Artica, or anyone else who replied, do you know if the improvement was enough to restore fully functioning lives to the patients thus freeing them from taking zombifying meds, allowing independent living, the ability/motivation to attain meaningful work, etc?

Will there be more studies in the near future? If anyone knows of a research study please message me. Thank You.
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It's trickling down if you look in the right places. It seems that a lot of big cities now have ketamine infusion clinics, which are beyond my financial means personally, so I'm having it prescribed by my regular shrink. It's a controlled drug, but legal to prescribe. I think there was someone on here named ketadvocate that had a state-by-state list of doctors known to prescribe it. I get mine through a compounding pharmacy. I've been taking it since the beginning of last September and have noticed big improvements. It hasn't magically turned my life around, but I can see some actual progress being made, which I haven't seen in a long time.
 
endotropic said:
I hope we see more trials on using Ketamine for depressive episodes caused by conditions other than MDD in the near future. I know that anecdotally ketamine has been very effective in bipolar patients who are refractory to other treatments, now it's time to see some data.

The majority of the medical community is still very skeptical about the whole topic ("of course they feel better, they're tripping balls!"). I've mentioned the success people have been having with ketamine to some doctors in my area, and by their responses you would think I was encouraging expectant mothers to take up heroin. Hopefully the authors of this trial do a good job publishing their results so more people are aware of what's been happening behind the scenes.
Click to expand...

I found this article in the references of the ECT vs. ketamine article, and they used intranasal ketamine to treat bipolar kids (6-19 years) with a Fear of Harm profile:

http://www.ncbi.nlm.nih.gov/pubmed/?term=papolos+ketamine

I'd also love to see the full text of this article, if anyone can dig it up. Thanks!
 
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