Ketamine versus electroconvulsive therapy for major depressive episode: An updated systematic review and non-inferiority meta-analysis.

Autor: Petrucci ABC; Center of Medical Sciences, Federal University of Paraíba, University City, n/a, President Castelo Branco III. Complex, João Pessoa, Paraíba, Brazil., Fernandes JVA; Center of Medical Sciences, Federal University of Paraíba, University City, n/a, President Castelo Branco III. Complex, João Pessoa, Paraíba, Brazil., Reis IA; Center of Medical Sciences, Federal University of Paraíba, University City, n/a, President Castelo Branco III. Complex, João Pessoa, Paraíba, Brazil., da Silva GHS; Center of Health Sciences, Catholic University of Pernambuco, Príncipe Street, 693, Soledade, Recife, Pernambuco, Brazil., Recla BMF; Multivix Vitória University Center, José Alves Street, 301, Goiabeiras, Vitória, Espírito Santo, Brazil., de Mendonça JC; Multivix Vitória University Center, José Alves Street, 301, Goiabeiras, Vitória, Espírito Santo, Brazil., Pedro VCS; Center of Medical Sciences, Federal University of Paraíba, University City, n/a, President Castelo Branco III. Complex, João Pessoa, Paraíba, Brazil., D'Assunção LEN; Center of Medical Sciences, Federal University of Paraíba, University City, n/a, President Castelo Branco III. Complex, João Pessoa, Paraíba, Brazil., Valiengo LDCL; Laboratory of Neurosciences (LIM-27), Institute of Psychiatry, University Hospital, University of São Paulo, Doctor Ovídio Pires de Campos Street, 785, Cerqueira César, São Paulo, São Paulo, Brazil. Electronic address: valiengo@usp.br.
Jazyk: angličtina
Zdroj: Psychiatry research [Psychiatry Res] 2024 Sep; Vol. 339, pp. 115994. Date of Electronic Publication: 2024 May 31.
DOI: 10.1016/j.psychres.2024.115994
Abstrakt: We conducted a systematic review and meta-analysis to investigate the comparative effectiveness of ketamine versus electroconvulsive therapy (ECT) for the treatment of major depressive episodes (MDEs). PubMed, EMBASE and Cochrane Library databases were systematically searched for randomized controlled trials (RCTs) comparing ketamine and ECT for MDE. The primary outcome was response rate, for which we prespecified a non-inferiority margin of -0.1, based on the largest and most recent RCT. Response was defined as a reduction of at least 50 % in the depression scale score. Six RCTs met the inclusion criteria, comprising 655 patients. In the overall population, ketamine was not non-inferior to ECT in response rate (RD -0.10; 95 % CI -0.26 to 0.05; p = 0.198; I 2 = 72 %). The ECT group had a higher reduction in depression scores, but without difference in remission and relapse rates. Regarding safety outcomes, ketamine had better posttreatment cognition scores and reduced muscle pain rate compared with ECT, albeit with an increased rate of dissociative symptoms. In a subanalysis with only inpatients, ketamine was inferior to ECT in response rate (RD -0.15; 95 % CI -0.27 to -0.03; p = 0.014; I 2 = 25 %), remission, and change in depression scores. These findings support the use of ECT over ketamine for inpatients. Further RCTs are warranted to clarify the comparative effect of these treatments for outpatients.
Competing Interests: Declaration of competing interest The authors report no relationships that could be construed as conflicts of interest. All the authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. There were no external funding sources for this study.
(Copyright © 2024 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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