Antidepressant ketamine may be more effective than electroconvulsive therapy

Woman in a hosptial with an IV drip in her hand and arm. (Richard Coote)

A study conducted at the Johns Hopkins School of Medicine hints that IV administration of ketamine – a medication that is now being prescribed by a handful of psychiatrists to treat depression – may be more effective than other antidepressants or even electroconvulsive therapy (ECT).

Ketamine is a synthetic molecule that has been used as an anesthetic agent in humans and as a tranquilizing agent in animals.  It is considered safe when used as directed, even in children.  Ketamine, of course, is also sometimes abused as a street drug known as “Special K.”  But when drug abusers use it in this way, they swallow very high doses of the medication.

This newest data compared three intravenous (IV) infusions of ketamine – which has no known long-term side effects – to three ECT sessions.  In these sessions, patients must be completely anesthetized while seizures are triggered in the patient’s brain, which can sometimes lead to memory loss.  Patients who were hospitalized for severe depression were randomly assigned to receive either the ketamine or the ECT.

Ketamine infusions were found to provide superior relief to ECT and to bring relief more quickly.  Additionally, ketamine was found to be more powerful than ECT at 24 hours after treatment, 72 hours after treatment and one week after treatment.

In my own practice, I now offer depressed patients ketamine infusions, which are delivered by a colleague and partner of mine who is an internal medicine physician. I select patients who have not benefited sufficiently from oral medications like Lexapro or Effexor.

I have been astounded by the positive results.  Ketamine has worked for many of my patients when no other medication has.  And using ketamine has commonly provided quick relief that has sometimes lasted permanently, or that can be made to last with a simple regimen of repeated IV infusions given every few months.

Not every patient responds to ketamine, but the vast majority of my patients who have used the medication do respond.

One added benefit of ketamine is that its rapid, positive effects allow patients to participate in psychotherapy sooner and, seemingly, in an even more effective manner.

While we already know that ketamine is also sometimes very powerful as a treatment for unremitting chronic pain, other questions still need to be answered.  Should ketamine be used even before other medications are tried – as a first-line strategy?  Could ketamine be used to prevent major depression?  What other benefits might ketamine offer to those who suffer with panic disorder, PTSD or Obsessive-Compulsive Disorder?

Research always takes time, and more data will be forthcoming from ongoing research trials at Massachusetts General Hospital and elsewhere.  But when a medication with so few side effects beats ECT, even in a limited and small study like the Johns Hopkins one, patients need to know.