Ketamine versus ECT for Nonpsychotic Treatment-Resistant Major Depression
If I am a candidate for ECT, is IV ketamine a reasonable first option given this head-to-head result?
Top of the evidence hierarchy, independently funded. how we score evidence
Caveat on this rating: Open-label by necessity (neither ketamine nor ECT can be masked), so subjective outcomes may favor the treatment patients preferred; population excluded psychotic depression, where ECT performs best.
esketamine (Spravato) only — TRD 2019, monotherapy Jan 2025, REMS in force. Racemic ketamine is approved as an anesthetic; its psychiatric use is off-label.
In 403 patients with nonpsychotic treatment-resistant depression (ELEKT-D), IV ketamine was noninferior to ECT over 3 weeks (response 55.4% vs 41.2%), with less memory impairment than ECT — the largest independent trial of ketamine for depression to date.
Worth asking
If I am a candidate for ECT, is IV ketamine a reasonable first option given this head-to-head result?
Source
Ketamine versus ECT for Nonpsychotic Treatment-Resistant Major Depression — Anand A, et al. (2023)
Top-tier peer-reviewed journal
Read the source: https://doi.org/10.1056/NEJMoa2302399
DOI: 10.1056/NEJMoa2302399
How this was scored
- Study design
- Randomised controlled trial
- Funding
- Independently funded
- Published in
- Top-tier peer-reviewed journal
- Sample size
- 403
- Preregistered
- Yes
- Conflicts disclosed
- not recorded
- Independent of proponent
- Yes
- Retracted
- No
Read the full scoring rubric, including what it can't tell you.
Published August 19, 2026.
Where we put this study in context
Questions
How strong is the evidence behind this?
Resolv rates this source "gold standard". Top of the evidence hierarchy, independently funded. It scores 87 out of 100 on our published rubric. One caveat travels with that badge: Open-label by necessity (neither ketamine nor ECT can be masked), so subjective outcomes may favor the treatment patients preferred; population excluded psychotic depression, where ECT performs best. The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
Ketamine versus ECT for Nonpsychotic Treatment-Resistant Major Depression — Anand A, et al. (2023). Published in: Top-tier peer-reviewed journal. DOI: 10.1056/NEJMoa2302399. The full source is linked on this page so you can read it yourself.
Who paid for this research, and does that matter?
Study design: Randomised controlled trial. Funding: Independently funded. The researchers were independent of whoever benefits from the result. Industry sponsorship is one of the most reliably measured biases in medicine, which is why funding carries real weight in the score rather than sitting in a footnote.
Is ketamine, ketalar FDA approved for this use?
No. No FDA review of this evidence for this use has taken place. esketamine (Spravato) only — TRD 2019, monotherapy Jan 2025, REMS in force. Racemic ketamine is approved as an anesthetic; its psychiatric use is off-label.
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.