Ketamine for Depression: A Super Speedy Review

Tune in to this week's podcast episode for a super speedy exploration of a groundbreaking study on treating resistant depression with ketamine versus electroconvulsive therapy. Led by Dr. Joshua Goldenberg, we discuss key trial details, revealing raw facts and fascinating findings in evidence-based integrative medicine. Uncover unexpected suicide attempt rates, trial design nuances, and potential implications swiftly. Engage with us on social platforms and www.drjournalclub.com, where your learning journey continues.

This is a research review. It is not meant to diagnose or treat disease. For all things medical contact your healthcare professional. This is meant for educational purposes only. It reviews a new research paper you can find here.

Anand A, Mathew SJ, Sanacora G, Murrough JW, Goes FS, Altinay M, Aloysi AS, Asghar-Ali AA, Barnett BS, Chang LC, Collins KA, Costi S, Iqbal S, Jha MK, Krishnan K, Malone DA, Nikayin S, Nissen SE, Ostroff RB, Reti IM, Wilkinson ST, Wolski K, Hu B. Ketamine versus ECT for Nonpsychotic Treatment-Resistant Major Depression. N Engl J Med. 2023 Jun 22;388(25):2315-2325. doi: 10.1056/NEJMoa2302399. Epub 2023 May 24. PMID: 37224232.

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Transcript

Introducer: 0:02

Welcome to the Dr Journal Club podcast, the show that goes under the hood of evidence-based integrative medicine. We review recent research articles, interview evidence-based medicine thought leaders and discuss the challenges and opportunities of integrating evidence-based and integrative medicine. Continue your learning after the show at www. drjournalclub. com.

Josh: 1:09

Hello and welcome to another super speedy summary. This is your host, oshua Goldenberg. Today we're going to talk about a very interesting study on ketamine for depression. We know that everyone has been asking about this, so we were very excited to do the full review and, of course, as always, for the basic level and in-depth level video to really get into the nitty-gritty of this study. Go ahead and watch those videos where Dr Adam Sadowski just does a really excellent job.

Josh: 1:36

So this was a paper that came out in this year 2023, in the New England Journal of Medicine Dr. Sadowski's favorite journal, where you're basically comparing ketamine to electroconvulsive therapy for a non-psychiatric treatment resistant depression, major depression and so obviously, major treatment resistant depression is an issue because it's resistant to treatment and can be quite dangerous with very high suicide attempt rates. I was actually quite surprised to see some of the baseline data on the percentage of folks in each group that had a history of attempting suicide. And the question was this was a non-inferiority trial, so it was designed to see was ketamine at least non-inferior to electroconvulsive therapy? It was not set up to say that it was better than or not. And so what we have this was a open label, randomized non-inferiority trial. 403 patients that were referred to electroconvulsive therapy clinics for treatment resistant major depression were randomized in a one to one ratio and they were either given ketamine IV two times per week or electroconvulsive therapy three times per week and they were looking at different validated metrics of response to show response to treatment in a lot of numerous primary and secondary outcomes. Again, for more details, watch the basic and in-depth level video. So what did they find? So clinical response we have over 50%, so 54%, responders in the ketamine group versus 41% in the electroconvulsive therapy group, so a larger number of people improved clinically. Of course this is designed to say it's non-inferior, so we could say that ketamine at least is non-inferior to electroconvulsive therapy. And just the raw numbers seems to be superior, but again, it was not designed statistically to say that Electroconvulsive therapy was associated with a decrease in memory recall, which improved over time after treatment. Improvements in quality of life were similar. There were musculoskeletal adverse events with electroconvulsive therapy and there was a dissociation associated with the ketamine treatment. So a very tough condition, very promising results, and we are looking forward to more rigorous study designs. Moving forward, go ahead and watch the full basic and in-depth level video with Dr. Adam Sadowski on Dr Journal Club.

Josh: 4:11

If you enjoy this podcast, chances are that one of your colleagues and friends probably would as well. Please do us a favor and let them know about the podcast and, if you have a little bit of extra time, even just a few seconds, if you could rate us and review us on Apple Podcast or any other distributor. It would be greatly appreciated. It would mean a lot to us and help get the word out to other people that would really enjoy our content. Thank you, hey y'all.

Josh: 4:33

This is Josh. You know we talked about some really interesting stuff today. I think one of the things we're going to do that's relevant. There is a course we have on Dr Journal Club called the EBM Boot Camp that's really meant for clinicians, to sort of help them understand how to critically evaluate the literature, et cetera, et cetera some of the things that we've been talking about today. Go ahead and check out the show notes link. We're going to link to it directly. I think it might be of interest. Don't forget to follow us on social and interact with us on social media at Dr Journal Club. Dr Journal Club on Twitter, we're on Facebook, we're on LinkedIn, et cetera, et cetera. So please reach out to us. We always love to talk to our fans and our listeners. If you have any specific questions you'd like to ask us about research, evidence, being a clinician, et cetera, don't hesitate to ask. And then, of course, if you have any topics that you'd like us to cover on the pod, please let us know as well.

Introducer: 5:26

Thank you for listening to the Dr Journal Club Podcast, the show that goes under the hood of evidence-based integrative medicine. We review recent research articles, interview evidence-based medicine thought leaders and discuss the challenges and opportunities of integrating evidence-based and integrative medicine. Be sure to visit www. drjournalclub. com to learn more.