ELEctroconvulsive therapy (ECT) vs. Ketamine in patients with Treatment-resistant Depression: The ELEKT-D study...

Area of Science:

• Neuroscience
• Psychiatry
• Clinical Trials

Background:

• Major depressive disorder (MDD) is a leading cause of global disability.
• Electroconvulsive therapy (ECT) is highly effective for MDD and treatment-resistant depression (TRD) but underutilized.
• Ketamine offers rapid antidepressant effects but has long-term safety concerns.

Purpose of the Study:

• To compare the effectiveness and safety of ECT versus ketamine in patients with TRD.
• To determine if ketamine is non-inferior to ECT for treating TRD.
• To provide data for informed clinical decisions and health policy regarding TRD treatments.

Main Methods:

• The ELEKT-D study is a non-inferiority, randomized controlled trial.
• 400 patients with TRD will be randomized (1:1) to receive either ECT (thrice weekly) or intravenous ketamine (twice weekly) for 3-5 weeks.
• The primary outcome is the proportion of responders, measured by the Quick Inventory of Depressive Symptomatology-Self Report.

Main Results:

• The study is powered to detect non-inferiority if ketamine retains 90% of the ECT treatment effect.
• Secondary outcomes include remission rates, depression severity, cognitive function, quality of life, and adverse events.
• Head-to-head comparison of ECT and ketamine in a large, well-powered trial is lacking.

Conclusions:

• The ELEKT-D study will provide crucial head-to-head data on ECT versus ketamine for TRD.
• Results will impact patient treatment choices, clinical guidelines, and insurance policies.
• Understanding comparative effectiveness is vital for optimizing care for major depressive disorder.