Severe Melancholic Depression: Urgent ECT and Utilizing Ketamine (Node 3a)
November 2, 2019 DOI: 10.64239/pi-vl2406 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Practical guide or manual |
|---|---|
| Interventions | ECT Ketamine |
| Topics | Depression Esketamine Ketamine |
| Key points | Proposes that ECT is the first-line treatment for melancholic depression with urgent indications, citing a 75% remission rate, and suggests ketamine infusion as an alternative for rapid response when ECT is refused or intolerable, while acknowledging insufficient evidence for long-term ketamine use. |
Abstract
The algorithm for depressed inpatients with melancholia starts with considering whether there is an urgent indication for ECT. Imminent risk of suicide, catatonia, inadequate oral intake, and a past history of good response to ECT may be indications for ECT. Remission rates of 75% have been reported with ECT. If the patient has these indications but refuses or is intolerant of ECT, consider an infusion of ketamine for rapid response of symptoms. This could be followed by ECT, if now acceptable, or pharmacotherapy (see next video for options). However, evidence on long-term use of ketamine is lacking.