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Combination of ketamine and electroconvulsive therapy in treatment resistant depression.

Burcu Kök Kendirlioğlu, Melike Özmen, Sudesu Uluçay, Tolga Bayrak, Elif Sude Erturan, Özge Salkım, Ayşe Ece Büyüksandalyacı Tunç, Hidayet Ece Arat Çelik, Suat Küçükgöncü

Journal of Affective Disorders July 15, 2025 DOI: 10.1016/j.jad.2025.04.017 (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Retrospective study Peer reviewed
Sample size 30
Population Patients with treatment-resistant depression
Interventions Electroconvulsive therapy intravenous racemic ketamine
Duration 6-month and 1-year follow-up after remission
Topics Depression Ketamine Esketamine
Keywords Electroconvulsive therapy Unipolar depression Depression therapy Ketamine treatment Mental health interventions
Citations 3
Key points Adding intravenous ketamine to ECT on consecutive days did not significantly improve depression remission rates compared with ECT alone.

Abstract

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.

Comparable studies

Other observational and cohort studies on ketamine for depression, most cited first.

Study Year Design Participants
Concomitant BDNF and sleep slow wave changes indicate ketamine-induced plasticity in major depressive disorder Patients with treatment-resistant major depressive disorder 2012 Observational cohort n = 30
Altered peripheral immune profiles in treatment-resistant depression: response to ketamine and prediction of treatment outcome Healthy controls and actively depressed patients with treatment-resistant depression... 2017 Observational cohort n = 59
Clinical Predictors of Ketamine Response in Treatment-Resistant Major Depression Treatment-resistant inpatients with DSM-IV-TR-diagnosed major depressive disorder or... 2014 Post hoc analysis of pooled data from four studies n = 108
An investigation of amino-acid neurotransmitters as potential predictors of clinical improvement to ketamine in depression Drug-free patients with major depressive disorder 2011 Observational cohort n = 14
Efficacy of ketamine therapy in the treatment of depression Drug-free/naïve men with severe depression, no history of psychotic disorder, head... 2019 Observational cohort n = 25

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