Ketamine versus ECT for Nonpsychotic Treatment-Resistant Major Depression

To the Editor: The article by Anand et al. (June 22 issue)(1) concerns an important issue - the therapeutic approach that should be used for patients with treatment-resistant depression. However, the article has some drawbacks. First, bilateral electroconvulsive therapy (ECT) is standard care for treatment-resistant depression. Bilateral ECT has a faster onset and is more efficacious than unilateral ECT.(2) The patients in this trial who ultimately underwent ECT started with unilateral ECT, which may be an indication that the authors were biased toward the ketamine group. It is awkward that after a median of four sessions, 38.8% of the patients . . .