I love working with Elixir but I would probably say that I found building queries in SQLAlchemy a bit more straight-forward than in Ecto. While I'd rather do basically everything else in Ecto.
I think most of the similarities is because they are both providing abstraction on top SQL, which tends to lead to a similar enough API surface. I don't know what primarily influenced Ecto. But I think it was quite intentionally not Django ORM or ActiveRecord. Working with Ecto and SQLAlchemy at different times I don't find them very similar beyond all the SQL terminology and API surface they share. So yeah, maybe superficial, and yes an older pattern, SQL ;)
SQLAlchemy + Alembic cover a very large feature set for ORM, query building, migrations and all of that stuff in a way I think works pretty darn well. It simplifies building SQL queries piece by piece but gets very complex for certain queries.
But a lot of projects I've seen around the web try to bend the sqlalchemy ORM into a more "active record" way of working.