Combining Intranasal Esketamine and Electroconvulsive Therapy in Severe Treatment‑Resistant Depression: A Case Series.
The journal of ECT January 29, 2026 Sergi López-rodríguez, Aida De Arriba-Arnau, José Manuel Menchón et al. 1 citation
Combining electroconvulsive therapy (ECT) with intranasal esketamine (ESK) may offer sustained improvement for adults with severe treatment-resistant depression who had only partial benefit from either treatment alone. In four patients aged 50 to 72, the combination reduced depression scores by an average of 58% over 24 weeks, with no relapses. Two patients who added the complementary treatment to partial monotherapy showed symptom reductions of 50% and 37%. Two others who were already responding to maintenance ECT had further improvements of 62% and 83%, allowing ECT sessions to be spaced from weekly to every two to three weeks. Side effects were mild and temporary, including brief dissociation and post-ictal confusion. These findings suggest the combination is feasible and warrants controlled trials.