Electroconvulsive Therapy and Ketamine Infusion in Patients with Bipolar I or II Depression: A Case Series.
Keming Gao, Evrim Bayrak Oruc, Heather Wobbe, Margret A Musso, Buket Koparal
Psychopharmacology Bulletin June 5, 2026 DOI: 10.64719/pb.18534 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Retrospective chart review Randomized Case report Peer reviewed |
|---|---|
| Sample size | 6 |
| Population | Patients with bipolar I or II depression who received both ECT and ketamine infusion |
| Interventions | Electroconvulsive therapy Ketamine infusion |
| Topics | Ketamine Depression Esketamine |
| Keywords | Efficacy Electroconvulsive therapy Safety Treatment-resistant bipolar depression |
| Key findings | Most patients responded well to ECT, and half of those also responded to ketamine infusion, but the onset of antidepressant effect differed between the two treatments. |
Abstract
To compare the efficacy and safety of electroconvulsive therapy (ECT) and ketamine infusion (KET-IFU) in routine care for patients with bipolar I or II depression (BPD). Electronic medical records of patients who received ECT and/or KET-IFU were used to identify patients with BPD who received both ECT and KET-IFU treatments. The change in the 16-item Quick Inventory of Depressive Symptomatology Self-Report (QIDS-16-SR) total score was used as an efficacy outcome. Self-reported side effects and Montreal Cognitive Assessment (MoCA) were used as safety measures. Six patients with BPD received both ECT and KET-IFU treatments. All patients received ECT first. Five patients received KET-IFU due to subjective memory concerns from ECT although their MoCA scores were within normal range. One patient with multiple previous ECT series received two KET-IFU series followed by an ECT series. Four patients responded to acute ECT treatments well with ⩾ 50% improvement in QIDS-16-SR total scores. Two of them also responded to KET-IFU well with ⩾ 50% improvement but the onset of antidepressant effect differed. One patient did not respond to ECT or KET-IFU. The patient who had two series of KET-IFU responded well during the first KET-IFU series but had limited benefit from the second KET-IFU series. No patient discontinued KET-IFU due to an adverse event. Most patients responded to ECT well and half of them had similar benefit from KET-IFU as from ECT. Randomized, head-to-head comparison studies of ECT versus KET-IFU in BPD are warranted to confirm or refute these findings.
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 |