Treatment escalation in patients not responding to pharmacotherapy, psychotherapy, and electro-convulsive therapy: experiences from a novel regimen using intravenous S-ketamine as add-on therapy in treatment-resistant depression

J Neural Transm (Vienna). 2016 May;123(5):549-52. doi: 10.1007/s00702-015-1500-7. Epub 2015 Dec 31.


A lack of response despite maximum therapy is common in patients fulfilling criteria of treatment-resistant depression. Therefore, innovative strategies for treatment escalation are warranted. Here, we report the clinical experiences associated with a novel therapeutic regimen combining electroconvulsive therapy and repeated intravenous S-ketamine treatment in three patients. The combined therapy was feasible and had no serious side effects. All patients responded to the new treatment option. The augmentative effect of sub-anesthetic S-ketamine on ECT is discussed.

Keywords: Electroconvulsive therapy; Innovative antidepressive strategies; Ketamine; Treatment resistant depression.

MeSH terms

  • Aged
  • Antidepressive Agents / therapeutic use*
  • Depressive Disorder, Treatment-Resistant / therapy*
  • Electroconvulsive Therapy / methods*
  • Excitatory Amino Acid Antagonists / therapeutic use*
  • Female
  • Humans
  • Ketamine / therapeutic use*
  • Male
  • Middle Aged
  • Psychiatric Status Rating Scales
  • Psychotherapy / methods*
  • Treatment Outcome


  • Antidepressive Agents
  • Excitatory Amino Acid Antagonists
  • Ketamine