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Racemic Ketamine as an Alternative to Electroconvulsive Therapy for Unipolar Depression: A Randomized, Open-Label, Non-Inferiority Trial (KetECT)
Lund Univ, Sweden.
Lund Univ, Sweden.
Lund Univ, Sweden.
Lund Univ, Sweden.
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2022 (English)In: International Journal of Neuropsychopharmacology, ISSN 1461-1457, E-ISSN 1469-5111, Vol. 25, no 5, p. 339-349Article in journal (Refereed) Published
Abstract [en]

Background Ketamine has emerged as a fast-acting and powerful antidepressant, but no head to head trial has been performed, Here, ketamine is compared with electroconvulsive therapy (ECT), the most effective therapy for depression. Methods Hospitalized patients with unipolar depression were randomized (1:1) to thrice-weekly racemic ketamine (0.5 mg/kg) infusions or ECT in a parallel, open-label, non-inferiority study. The primary outcome was remission (Montgomery angstrom sberg Depression Rating Scale score <= 10). Secondary outcomes included adverse events (AEs), time to remission, and relapse. Treatment sessions (maximum of 12) were administered until remission or maximal effect was achieved. Remitters were followed for 12 months after the final treatment session. Results In total 186 inpatients were included and received treatment. Among patients receiving ECT, 63% remitted compared with 46% receiving ketamine infusions (P = .026; difference 95% CI 2%, 30%). Both ketamine and ECT required a median of 6 treatment sessions to induce remission. Distinct AEs were associated with each treatment. Serious and long-lasting AEs, including cases of persisting amnesia, were more common with ECT, while treatment-emergent AEs led to more dropouts in the ketamine group. Among remitters, 70% and 63%, with 57 and 61 median days in remission, relapsed within 12 months in the ketamine and ECT groups, respectively (P = .52). Conclusion Remission and cumulative symptom reduction following multiple racemic ketamine infusions in severely ill patients (age 18-85 years) in an authentic clinical setting suggest that ketamine, despite being inferior to ECT, can be a safe and valuable tool in treating unipolar depression.

Place, publisher, year, edition, pages
OXFORD UNIV PRESS , 2022. Vol. 25, no 5, p. 339-349
Keywords [en]
Electroconvulsive therapy; ketamine infusion; major depressive disorder; psychotic depression; racemic ketamine
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:liu:diva-184969DOI: 10.1093/ijnp/pyab088ISI: 000790043000001PubMedID: 35020871OAI: oai:DiVA.org:liu-184969DiVA, id: diva2:1658328
Note

Funding Agencies|Swedish Research Council [2015-00799]; Crafoord Foundation; Skane Regional Council; Konigska Foundation; Lions forsknings foundation Skane; OM Perssons donation foundation

Available from: 2022-05-16 Created: 2022-05-16 Last updated: 2023-04-06Bibliographically approved

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Nordanskog, Pia

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Center for Social and Affective Neuroscience (CSAN)Faculty of Medicine and Health SciencesPsykiatriska kliniken i LinköpingCenter for Social and Affective Neuroscience
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