Ketamine noninferior to ECT for nonpsychotic treatment-resistant major depression, with some advantages (ELEKT-D)

Clinical Question

For patients with nonpsychotic treatment-resistant major depression, is ketamine noninferior to electroconvulsive therapy?

Bottom line

For patients with nonpsychotic major depression who do not respond to antidepressants, ketamine offers some advantages over ECT in this largest comparative trial to date, including no need for general anesthesia and no memory impairment. 1b-

Study design: Randomized controlled trial (nonblinded)

Funding: Government

Setting: Outpatient (specialty)


Mark H. Ebell, MD, MS
University of Georgia
Athens, GA

Discuss this POEM



Ketamine infusion treatments for major depression

I'd read a book several years ago about this (then) experimental therapy for major drug resistant depression. It may represent an exciting new option for these several ill patients


Impact assessment


Pieter Richard Verbeek

Ketamine vs ECT for resistant depression

I am cautiously optimist about the results. A fairly small, non-blinded study with a significant number of patients randomized to ECT who ended up not receiving the assigned treatment which necessitated a modified intention to treat analysis. Clearly more trials are required. Not able to clinically comment on the lone patient with attempted suicide that came from the ketamine group however had it been an attempt resulting in death additional concern would be raised. To me, lots of work remains to be done before ketamine is accepted as a mainstream option.


ketamin vs ect

good to know

Maris Andersons

Ketamine vs ECT

Good preliminary data! More Data is needed


Ketamine for depression

Don't position yourself on the wrong side of medical history. This is not a solution!