Ketamine provides rapid but short-lived antidepressant effects. In an open-label trial, patients with treatment-resistant depression received a 2-week course of intravenous ketamine alongside a 10-week course of cognitive behavioral therapy (CBT). Of 16 participants, 8 responded to ketamine and 7 achieved remission in the first 2 weeks. Among responders, 25% relapsed by the end of CBT, and the median time to relapse was 12 weeks after ketamine. Among remitters, 2 of 7 maintained remission through 8 weeks after ketamine. Ketamine nonresponders did not benefit from CBT. The combination may help sustain ketamine's effects, but randomized controlled trials are needed.
Cognitive behavioral therapy (CBT) may help sustain the antidepressant effects of ketamine in people with treatment-resistant depression. In a trial, 42 patients with treatment-resistant depression received six intravenous ketamine infusions over three weeks. The 28 who responded were then randomized to CBT or treatment as usual for 14 weeks. On one depression scale, the CBT group showed significantly greater sustained improvement, with a moderate-to-large effect size. A smaller subset of ketamine responders also improved in emotional cognitive accuracy, while nonresponders did not. The findings are preliminary and need confirmation in larger trials.