PMID- 35020871
OWN - NLM
STAT- MEDLINE
DCOM- 20220602
LR  - 20220716
IS  - 1469-5111 (Electronic)
IS  - 1461-1457 (Print)
IS  - 1461-1457 (Linking)
VI  - 25
IP  - 5
DP  - 2022 May 27
TI  - Racemic Ketamine as an Alternative to Electroconvulsive Therapy for Unipolar 
      Depression: A Randomized, Open-Label, Non-Inferiority Trial (KetECT).
PG  - 339-349
LID - 10.1093/ijnp/pyab088 [doi]
AB  - 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 
      Asberg 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.
CI  - (c) The Author(s) 2021. Published by Oxford University Press on behalf of CINP.
FAU - Ekstrand, Joakim
AU  - Ekstrand J
AD  - Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, 
      Sweden.
FAU - Fattah, Christian
AU  - Fattah C
AD  - Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, 
      Sweden.
FAU - Persson, Marcus
AU  - Persson M
AD  - Department of Clinical Sciences, Faculty of Medicine, Lund University, 
      Helsingborg, Sweden.
FAU - Cheng, Tony
AU  - Cheng T
AD  - Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmo, 
      Sweden.
FAU - Nordanskog, Pia
AU  - Nordanskog P
AD  - Department of Clinical and Experimental Medicine, Linkoping University, 
      Linkoping, Sweden.
FAU - Akeson, Jonas
AU  - Akeson J
AD  - Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmo, 
      Sweden.
FAU - Tingstrom, Anders
AU  - Tingstrom A
AD  - Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, 
      Sweden.
FAU - Lindstrom, Mats B
AU  - Lindstrom MB
AD  - Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmo, 
      Sweden.
FAU - Nordenskjold, Axel
AU  - Nordenskjold A
AUID- ORCID: 0000-0001-7454-3065
AD  - Faculty of Medicine and Health, Orebro University, Orebro, Sweden.
FAU - Movahed Rad, Pouya
AU  - Movahed Rad P
AUID- ORCID: 0000-0003-2041-3550
AD  - Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, 
      Sweden.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Int J Neuropsychopharmacol
JT  - The international journal of neuropsychopharmacology
JID - 9815893
RN  - 0 (Antidepressive Agents)
RN  - 690G0D6V8H (Ketamine)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Antidepressive Agents/adverse effects
MH  - *Depressive Disorder, Major/drug therapy
MH  - *Depressive Disorder, Treatment-Resistant/drug therapy
MH  - *Electroconvulsive Therapy/adverse effects
MH  - Humans
MH  - *Ketamine/adverse effects
MH  - Middle Aged
MH  - Treatment Outcome
MH  - Young Adult
PMC - PMC9154276
OTO - NOTNLM
OT  - Electroconvulsive therapy
OT  - ketamine infusion
OT  - major depressive disorder
OT  - psychotic depression
OT  - racemic ketamine
EDAT- 2022/01/13 06:00
MHDA- 2022/06/03 06:00
PMCR- 2021/12/04
CRDT- 2022/01/12 17:32
PHST- 2021/08/24 00:00 [received]
PHST- 2021/11/19 00:00 [revised]
PHST- 2021/12/03 00:00 [accepted]
PHST- 2022/01/13 06:00 [pubmed]
PHST- 2022/06/03 06:00 [medline]
PHST- 2022/01/12 17:32 [entrez]
PHST- 2021/12/04 00:00 [pmc-release]
AID - 6451171 [pii]
AID - pyab088 [pii]
AID - 10.1093/ijnp/pyab088 [doi]
PST - ppublish
SO  - Int J Neuropsychopharmacol. 2022 May 27;25(5):339-349. doi: 10.1093/ijnp/pyab088.