Ketamine compared with other depression treatments
Ketamine works faster than most depression treatments but needs clinic visits with monitoring, and its benefit often fades without continued care. It is usually considered after other treatments have not helped. In a 2023 trial of 403 adults with treatment-resistant depression without psychosis, ketamine did at least as well as ECT.
How ketamine and esketamine compare with antidepressants, TMS and ECT for depression: speed, setting, side effects and what the head-to-head ELEKT-D trial found.
Where ketamine fits, and where other options come first.
Key takeaways
- Antidepressants and therapy remain first-line for most people.
- Ketamine is usually considered for treatment-resistant depression.
- In ELEKT-D, 55.4% responded to ketamine and 41.2% to ECT after three weeks.
- ECT caused more memory decline at the end of treatment; ketamine caused more dissociation.
What the ELEKT-D trial showed
ELEKT-D, published in the New England Journal of Medicine in 2023, randomized 403 adults with treatment-resistant major depression without psychotic features to ketamine or ECT. After three weeks, 55.4% responded to ketamine and 41.2% to ECT, and remission was 32.3% versus 20%. The trial excluded people with psychotic depression, for whom ECT remains an important option.
Choosing between options
The right choice depends on your history, how severe and urgent your symptoms are, other conditions, access and cost. These are decisions to make with a psychiatrist. Beiing's therapy pages explain each option in more depth.
Frequently asked questions
Is ketamine better than ECT?
For adults with treatment-resistant depression without psychosis, one large trial found ketamine at least as effective as ECT over three weeks. That does not make it better for everyone, and longer-term comparisons are limited.
Related on Beiing
- TMS therapy - Magnetic stimulation explained.
- Therapy options - All treatment approaches compared.
- Ketamine for mental health - The hub for every page in this guide.
Sources
- Ketamine comparable to ECT for many patients with refractory depression (ELEKT-D trial, New England Journal of Medicine, 2023) - Psychiatric News (American Psychiatric Association)
- SPRAVATO (esketamine) nasal spray, prescribing information - Janssen Pharmaceuticals, via DailyMed (U.S. National Library of Medicine)
- SPRAVATO approved in the U.S. as the first and only monotherapy for adults with treatment-resistant depression (21 January 2025) - Johnson & Johnson (manufacturer press release)
Written by Beiing Editorial Team · Editorially reviewed by Beiing Editorial & Research Review · Published · Last reviewed . Editorial and research review by Beiing writers and researchers. This is not medical or clinical review, and no clinician signs off on our content.
Educational content only - not medical advice. In a crisis, call or text 988 (US) or your local emergency number. See crisis resources.