[larryliu]

Ketamine is a prescription medicine that can be taken oral, intranasal or IV drip.

ECT is an inpatient procedure that need one anesthesiologist and one psychiatrist plus nurses to administer, two to three times weekly for three to four weeks.

Who pays for the healthcare, definitely want to try the former and use the latter only if the former works poorly.

[richardjam73]

ECT also requires general anesthetic so for every treatment there is a much greater risk than for Ketamine.

[cryptoanon]

How do we know that the multiple sessions of general anesthetic isn’t doing the legwork against the depression? I read the article and there were very scant details.

[operator-name]

ECT, due to the potential side effects and Ketamine due to how recent it is are both near the "last lines of defence".

IRRC both of them cannot compare to psychotherapy, which has far higher effectiveness at the cost of far more resources.

[olliej]

> IRRC both of them cannot compare to psychotherapy,

The whole point of this, and numerous other articles is that this statement is objectively false.

If you have treatment resistant depression, PTSD, etc that treatment includes therapy.

Which is why ketamine and ECT are being investigated - for plenty of people these treatments have resolved things such that they do not need medical or therapy based treatment.

> which has far higher effectiveness at the cost of far more resources.

I'm guessing this is a typo, but given the cost of 1+ hours a week at easily $100-200/hr, for years - often without any limit at all - I'd be curious what the total cost is. This is especially important in this case as ECT, ketamine, etc treatments are _required_ to demonstrate efficacy, whereas psychotherapy has no such requirements.

There's been plenty of research over the years that has found pretty underwhelming outcomes from therapy based treatment outside of specific areas - more extreme are the therapy group/out-patient scams which have been shown very clearly to only work for groups of people with exactly the same trauma, and even then, only specific types of trauma.

It's a real problem in mental health treatment that only treatments that require the use of drugs and/or "surgical" procedure are required to provide evidence that they actually work.

[theGnuMe]

In the beginning we only had psychotherapy and it was like 15-30% successful IIRC.. so no, not necessarily.

[petesergeant]

I think it's a reasonable assumption that psychotherapy has improved since the 1940s/1950s when alternative medicines came out.

[richardjam73]

ECT has the highest cost of resources.

[olliej]

I'm guessing this was a typo, but if you look at how unbounded the time for psychotherapy to work, I would not be surprised if it did actually end up being the most expensive.