| Title: |
Ketamine vs Electroconvulsive Therapy for Treatment-Resistant Depression: A Secondary Analysis of a Randomized Clinical Trial |
| Authors: |
Jha, Manish Kumar; Wilkinson, Samuel T; Krishnan, Kamini; Collins, Katherine A; Sanacora, Gerard; Murrough, James; Goes, Fernando; Altinay, Murat; Aloysi, Amy; Asghar-Ali, Ali; Barnett, Brian; Chang, Lee; Costi, Sara; Malone, Donald; Nikayin, Sina; Nissen, Steven E; Ostroff, Robert; Reti, Irving; Wolski, Kathy; Wang, Dong; Hu, Bo; Mathew, Sanjay J; Anand, Amit |
| Source: |
Staff and Researcher Publications |
| Publisher Information: |
DigitalCommons@TMC |
| Publication Year: |
2024 |
| Collection: |
Houston Academy of Medicine-Texas Medical Center (HAM-TMC): DigitalCommons@The Texas Medical Center |
| Subject Terms: |
Humans; Ketamine; Electroconvulsive Therapy; Female; Male; Middle Aged; Depressive Disorder; Treatment-Resistant; Adult; Aged; Treatment Outcome; Medical Sciences; Medicine and Health Sciences; Mental and Social Health; Psychiatry and Psychology |
| Description: |
IMPORTANCE: The ELEKT-D: Electroconvulsive Therapy (ECT) vs Ketamine in Patients With Treatment Resistant Depression (TRD) (ELEKT-D) trial demonstrated noninferiority of intravenous ketamine vs ECT for nonpsychotic TRD. Clinical features that can guide selection of ketamine vs ECT may inform shared decision-making for patients with TRD. OBJECTIVE: To evaluate whether selected clinical features were associated with differential improvement with ketamine vs ECT. DESIGN, SETTING, AND PARTICIPANTS: This secondary analysis of an open-label noninferiority randomized clinical trial was a multicenter study conducted at 5 US academic medical centers from April 7, 2017, to November 11, 2022. Analyses for this study, which were not prespecified in the trial protocol, were conducted from May 10 to Oct 31, 2023. The study cohort included patients with TRD, aged 21 to 75 years, who were in a current nonpsychotic depressive episode of at least moderate severity and were referred for ECT by their clinicians. EXPOSURES: Eligible participants were randomized 1:1 to receive either 6 infusions of ketamine or 9 treatments with ECT over 3 weeks. MAIN OUTCOMES AND MEASURES: Association between baseline factors (including 16-item Quick Inventory of Depressive Symptomatology Self-Report [QIDS-SR16], Montgomery-Asberg Depression Rating Scale [MADRS], premorbid intelligence, cognitive function, history of attempted suicide, and inpatient vs outpatient status) and treatment response were assessed with repeated measures mixed-effects model analyses. RESULTS: Among the 365 participants included in this study (mean [SD] age, 46.0 [14.5] years; 191 [52.3%] female), 195 were randomized to the ketamine group and 170 to the ECT group. In repeated measures mixed-effects models using depression levels over 3 weeks and after false discovery rate adjustment, participants with a baseline QIDS-SR16 score of 20 or less (-7.7 vs -5.6 points) and those starting treatment as outpatients (-8.4 vs -6.2 points) reported greater reduction in the QIDS-SR16 with ... |
| Document Type: |
text |
| File Description: |
application/pdf |
| Language: |
English |
| Relation: |
https://digitalcommons.library.tmc.edu/clinic_pub/53; https://digitalcommons.library.tmc.edu/context/clinic_pub/article/1052/viewcontent/jha_2024_oi_240581_1718225904.99538.pdf |
| DOI: |
10.1001/jamanetworkopen.2024.17786 |
| Availability: |
https://digitalcommons.library.tmc.edu/clinic_pub/53; https://doi.org/10.1001/jamanetworkopen.2024.17786; https://digitalcommons.library.tmc.edu/context/clinic_pub/article/1052/viewcontent/jha_2024_oi_240581_1718225904.99538.pdf |
| Accession Number: |
edsbas.D875534A |
| Database: |
BASE |