%0 Journal Article
%T Ketamine and electroconvulsive therapy for severe depression: A network meta-analysis of efficacy and safety.
%A Liu Y
%A Yang J
%A Liu Y
%J J Psychiatr Res
%V 175
%N 0
%D 2024 May 11
%M 38744161
%F 5.25
%R 10.1016/j.jpsychires.2024.05.022
%X <B>BACKGROUND: </B>Ketamine, electroconvulsive therapy (ECT), and their combination are effective for treating severe depression, but few large-scale studies have compared these.<BR><B>METHODS: </B>We searched databases for randomized controlled trials (RCTs) using ketamine, ECT, ketamine + ECT, or placebo for severe depression. Standardized measures were efficacy outcomes. Risk of bias was assessed. Stata and ADDIS were used for network meta-analysis (NMA) comparing efficacy and adverse reactions post-treatment. This study was registered on PROSPERO (CRD42023476740).<BR><B>RESULTS: </B>17 RCTs with 1370 patients were included. NMA showed ECT and ketamine improved Hamilton Depression Rating Scale (HDRS) versus placebo; other comparisons not significant. Rank probabilities showed highest probability for ECT, followed by ketamine + ECT, ketamine, placebo. No differences in Montgomery-Asberg Depression Rating Scale (MADRS); highest rank probability again for ECT, followed by ketamine + ECT, ketamine, placebo.<BR><B>CONCLUSIONS: </B>Analysis suggests ECT superior to ketamine and their combination for improving depressive severity, but individualized treatment selection warranted. Higher adverse reactions with ketamine + ECT need further study for optimized combined use.