Combination of ketamine and electroconvulsive therapy in treatment resistant depression

Ketamine and electroconvulsive therapy (ECT) are among the recommended treatments for treatment resistant depression (TRD). However, there is a subset of patients who do not respond to either treatment, making it insufficient to address their condition. To determine the efficacy of concurrent therapy with ECT and intravenous racemic ketamine in TRD.

This retrospective study included a total of 30 patients' medical records between 2020 and 2024 which were followed up for 6 months and 1 year after remission. Two groups of fifteen patients were formed: those who received concurrent treatment of both ECT and ketamine on consecutive days and those who received ECT alone.

The mean age of the first group was 56.53 ± 4.83 years, and the mean age of the second group was 43.13 ± 5.13 years. The first group consisted of 80 % women and the second group of 40 % women. Mean age and number of previous depressive episodes were significantly higher in the first group (p = 0.034, F = 0.348; p = 0.019, U = 57.000). Treatment rates for both groups were 67.31 % and 67.22 % according to HDRS and no significant difference was found between the two groups. Nine (60 %) patients in the first group and 10 (66.6 %) patients in the second group did not require hospitalization during their follow-up.

The major limitations of our study are its retrospective design and the small number of patients.

If ketamine or ECT treatments are used separately in TRD and no response is obtained, we recommend ECT + ketamine concurrent treatment as a protocol in TRD.