Electroconvulsive shocks (ECS) and ketamine are fast-acting antidepressant treatments whose shared neurobiological mechanisms are explored in this systematic review of animal models of depression. Both interventions consistently increase hippocampal neurogenesis and brain-derived neurotrophic factor (BDNF) levels. They also positively affect glutamatergic neurotransmission, astrocyte and neuronal morphology, synaptic density, vasculature, and functional plasticity. Restoration of neuroplasticity may be a common mechanism underlying their antidepressant efficacy. Fewer studies have examined these processes after ECS. Understanding these shared fundamental mechanisms could help develop novel therapeutic approaches for severe depression.
A single 75 mg intranasal dose of ketamine reduces acute suicidal thoughts more than a 4 mg dose of the active placebo midazolam, measured 180 minutes after administration. The double-blind randomized trial includes 100 patients presenting with acute suicidality regardless of psychiatric diagnosis. The primary outcome is the change in suicidal ideation using the Beck Scale for Suicide Ideation. Secondary outcomes assess depression severity, tolerability, and biological markers. The study design addresses patient selection, ketamine formulation, clinical management, and follow-up timing.