For decades, if depression had not responded to medication, ECT was the main option left. Ketamine has changed that conversation, and until recently nobody had properly tested the two against each other.
This trial, published in the New England Journal of Medicine, randomly assigned 403 people with treatment-resistant depression — all of whom had already been referred to an ECT clinic — to receive either ECT three times a week or intravenous ketamine twice a week, for three weeks.
The headline result: ketamine was not inferior to ECT. Just over half the participants responded, meaning their depression scores at least halved. The researchers also tracked memory and quality of life, and followed people who improved for a further six months.
What makes this matter in real life is choice. These were people who had reached the point of being referred for ECT — the treatment most surrounded by fear and stigma — and the trial suggests there may be another route worth discussing.
Neither treatment is something you arrange yourself, and both need specialist care. But if you have been told nothing else is left to try, that is now less likely to be the whole story. Ask.