Journal of Psychedelic Psychiatry

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Journal of Psychedelic Psychiatry

Journal of Psychedelic Psychiatry

@psychedelic_org

The Journal of Psychedelic Psychiatry is dedicated to the analysis & publication of research designed to further the therapeutic utilization of psychedelics.

Katılım Ağustos 2019
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Tyler Kjorvestad
Tyler Kjorvestad@TylerKjorvestad·
@rbganatra I was listening to the latest @thecurbsiders podcast and your discussion about @NEJM's study on #Ketamine vs. #ECT for treatment of depression. Hopefully I provide few insights. 1. As you noted the Open Label, Outpatient design clearly favors Ketamine and also the potential bias exhibited by individual opting out of ECT prior to treatment and the lost to follow up issues with ECT also raise concerns. 2. ECT is well known to work better for severe inpatient depression (specifically catatonic, psychotic, and melancholic subtypes). 3. ECT is also traditionally done 3x/week for 4 weeks not 3 weeks. Right Unilateral placement is typically more common so would be the "standard of care" but if you want to determine efficacy Bilateral should have been used as this is more effective than RUL. 4. A recent study looking at ECT vs Ketamine in inpatients found ECT was still superior in this population (pubmed.ncbi.nlm.nih.gov/35020871/). 5. Additionally, studies have looked at adding Ketamine to ECT as the anesthetic agent and findings have not found any benefit in those patients compared to ECT and a traditional anesthesia agent (pubmed.ncbi.nlm.nih.gov/28383867/). 6. Regarding the QIDS to measure the primary outcome this psychometric tool may not be the best option to measure depression symptoms and has recently been called into question in other Psychiatric studies (pubmed.ncbi.nlm.nih.gov/37122239/). 7. In conclusion, this study design really was set up to favor Ketamine but given that Ketamine has more favorable risk profiles compared to ECT it is possible and based on my practice more likely that outpatients (event those with significant TRD) would opt and prefer Ketamine therapy compared to ECT. This is due to fewer weekly treatments and better recovery post treatments. All of this said more research is definitely needed and hopefully with better psychometric measures to adequately measure depression symptom burden.
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