Comparing the Cognitive Effects of Repeated Intravenous Ketamine and Electroconvulsive Therapy in Patients With Treatment-Resistant Depression

Summary & key facts

This randomized, multisite trial (ELEKT-D) compared 6 intravenous ketamine treatments with 9 electroconvulsive therapy (ECT) sessions in 365 people with treatment-resistant depression. At the end of the treatment course, people who got ECT performed worse than those who got ketamine on four objective cognitive tests (P < .001). Among people who responded to treatment (≥50% reduction in symptoms), there were no differences between the groups at 1-, 3-, and 6-month follow-ups. Subjective memory ratings gave mixed results: both groups improved on one memory questionnaire, but ketamine patients reported better self-rated memory while ECT patients reported a decline on another measure. Within the

Key facts:

• The trial was a multisite, randomized study run from April 2017 to November 2022 with an intent-to-treat sample of N = 365 participants with treatment-resistant depression.
• Participants received either 6 intravenous ketamine treatments or 9 ECT sessions before posttreatment cognitive testing.
• At the end of treatment, ECT recipients performed significantly worse than ketamine recipients on all four objective cognitive tasks (statistical significance P < .001).
• Responders were defined as people who had at least a 50% reduction in depressive symptoms; among these responders there were no significant cognitive differences between ketamine and ECT at 1-, 3-, and 6-month follow-ups.
• Subjective memory measures were mixed: Squire Memory Complaint Questionnaire (SMCQ) scores improved for both groups, but Global Self-Evaluation of Memory (GSE-My) scores improved for ketamine-treated patients and declined for ECT-treated pa
• Within the ketamine group, researchers found improvements in executive functioning and cognitive flexibility that remained after adjusting for changes in depression, suggesting those cognitive gains were at least partly independent of mood

Abstract

Trial Registration: ClinicalTrials.gov identifier: NCT03113968.

Topics

Electroconvulsive Therapy Studies Perfectionism, Procrastination, Anxiety Studies Treatment of Major Depression

Categories

Health Sciences Medicine Pharmacology

Tags

Anesthesia Cognition Depression (economics) Economics Electroconvulsive therapy Ketamine Macroeconomics Major depressive disorder Medicine Psychiatry Psychology Psychotherapist Treatment-resistant depression

Substances

Ketamine

Conditions & symptoms

Depression Difficulty focusing Lack of energy or motivation Sadness or low mood