Researchers at UT Southwestern Medical Centre have led a new analysis that suggests ketamine infusions may offer more symptom relief for patients with moderate to severe treatment-resistant depression (TRD) than electroconvulsive therapy (ECT). However, for patients with very severe TRD, ECT may be more beneficial early in treatment. JAMA Network Open published a groundbreaking study that has identified specific traits that could potentially revolutionise our understanding of the most effective treatment for individuals with TRD. This research marks a significant milestone in understanding how to tailor treatment plans to maximise benefits for patients.

"Patients with TRD and their doctors can incorporate our results into their collaborative decision-making process when choosing between ketamine and ECT," said Dr. Manish Jha, the primary author and an associate professor of psychiatry at UT Southwestern, who is also an O'Donnell Clinical Neuroscience Scholar. Dr. Jha, an investigator at the Peter O'Donnell Jr. Brain Institute, conducts groundbreaking research.

Up to one-third of adult patients with major depressive illness experience TRD, which is characterised by an inadequate response to two or more rounds of antidepressants. For decades, medical professionals have used ECT, a treatment that administers electric shocks to the brain, to treat individuals with TRD. Recently, medical professionals have used Ketamine, a medication known for its anaesthetic properties, to treat TRD.

Dr. Jha and his colleagues conducted the ELEKT-D clinical trial, led by Dr Amit Anand, Professor of Psychiatry at Harvard Medical School. Last year, the New England Journal of Medicine published a study that included 403 patients with TRD at five U.S. medical centres. A recent study has shown that both ECT and ketamine yield similar results. It remained unclear whether baseline patient features could indicate which medication would prove more effective.

To address this issue, Dr. Jha and research colleagues from across the United States examined a subgroup of 365 patients from ELEKT-D. A total of 195 individuals underwent up to six ketamine infusions within a span of three weeks, while 170 participants received up to nine ECT treatments. Patients diligently filled out a depressive symptoms questionnaire twice a week throughout the therapy phase and once during a follow-up after their therapies concluded. Madhukar Trivedi, M.D., a psychiatry professor, chief of the division of mood disorders, and founding director of the Centre for Depression Research and Clinical Care at UT Southwestern, along with former UTSW physician-researcher A. John Rush, M.D., Professor Emeritus at the Duke-NUS Medical School at the National University of Singapore, created the questionnaire.

The researchers conducted a comprehensive evaluation of the patients' clinical and demographic characteristics. The researchers included factors like age, sex, concurrent use of other treatments, cognitive function, and whether the patients were receiving inpatient or outpatient treatment for depression. The clinician used a diagnostic tool to assess the patients.

At baseline, researchers found that patients with moderate to severe overall depression or those receiving outpatient treatment are most likely to benefit from ketamine. Researchers drew this conclusion by comparing the patients' three-weekly symptom assessments with their demographic and clinical data. Patients with severe depression or those receiving inpatient treatment experienced greater benefits from early ECT treatment. Patients with these features achieved comparable results by their last visit when given ketamine.

According to Dr. Jha, when deciding on the appropriate course of action for patients with TRD, several factors are considered. These include potential side effects, insurance coverage, and the ease of accessing the medication. "Patients and doctors now have another factor to consider when choosing the best option," he stated, emphasising the findings from this analysis.

A new study highlights the importance of personalised treatment programmes and the need for patients and healthcare professionals to make decisions together in order to effectively manage treatment-resistant depression