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.
In eight adults with treatment-resistant obsessive-compulsive disorder and comorbid major depressive disorder, twelve weeks of intranasal esketamine (56-84 mg per session) substantially improved depressive symptoms, with MADRS scores decreasing by 48.8%. Obsessive-compulsive symptoms showed a more modest and heterogeneous reduction, with Y-BOCS scores decreasing by 30.3%. Half of participants achieved depression response, and half met OCD response criteria. Depressive symptoms improved earlier, while OCD symptoms followed a slower and more variable trajectory. These preliminary findings suggest that repeated intranasal esketamine may offer a therapeutic window for this severe subgroup, supporting further controlled studies.
In eight adults with treatment-resistant obsessive-compulsive disorder and major depression, adding intranasal esketamine to their existing treatment for 12 weeks reduced depressive symptoms by 48.8% and obsessive-compulsive symptoms by 30.4%. Four participants (50%) showed a depression response, with two (25%) achieving remission; three (37.5%) met the response criterion for OCD. The findings suggest esketamine may have dual benefits for both conditions, but controlled trials are needed to confirm these preliminary results.