ECT in depression –

Currently, there are two main treatments to fight depression, antidepressants and psychotherapy, while a third approach, electroconvulsive therapy (ECT), is regarded as a second- or third-line therapy that is usually resorted to in cases where medication and psychotherapy have failed (Kellner et al., 2016b; Karayagmurlu et al., 2019). However, most patients who were resistant to antidepressant or psychotherapy showed improvement after ECT was introduced. In other words, ECT may have a greater effect than the two routinely used methods in fighting depression

Cognitive decline was noted in some depressed patients who received ECT (Brus et al., 2017), and recovery from this declination was suggested to take half a year (Nuninga et al., 2018). However, whether ECT contributed more memory loss than pharmaceutical treatment is still in dispute, but the majority support the view of no additional cognitive damage ascribable to ECT than antidepressants (Husain et al., 2004; Kellner et al., 2016a, b; Bjoerke-Bertheussen et al., 2018). Nonetheless, some studies found no dementia in individuals who underwent ECT (Osler et al., 2018), and in geriatric depressed patients, ECT even improved cognitive function (Socci et al., 2018).

With respect to other common side effects that occurred during ECT treatment, headache and nausea/vomiting are believed to be the most common complaints (Kellner et al., 2006; Karayagmurlu et al., 2019). Thankfully, in the view of severity and prevalence, the ECT recipients reported less headache and nausea/vomiting in recent studies (Husain et al., 2004; McCall et al., 2018; Socci et al., 2018).

Ketamine in depression –

Recent studies are accepting the role of glutamate in depression, in particular NMDA receptors along with serotonin receptors. While conventional pharmacotherapy usually takes several weeks (usually 4-12 weeks) to improve symptoms, Ketamine is an N-methyl-D aspartate receptor antagonist having rapid action on depressive symptoms.

Regardless of the ketamine form, patients commonly experience dissociative adverse effects, such as psychosis-like conditions. In addition to the dissociative side effects of ketamine therapy, there are also physiological effects. For example, roughly 40% of people given a single dose of IV ketamine have increased heart rate and blood pressure for a limited time after treatment. Patients have also experienced symptoms including anxiety, blurred vision, dizziness, headache, nausea, or vomiting with the use of ketamine.

Eriksson notes that the peak concentration of oral ketamine is much lower than that of IV ketamine. Since ketamine’s action on NMDA receptors causes dissociative side effects, clinicians believe a lower peak dosage has improved tolerability.