A patient with bipolar treatment-resistant depression who had not responded to medication, psychotherapy, or either repetitive transcranial magnetic stimulation (rTMS) or intravenous ketamine alone achieved complete and sustained remission when rTMS and ketamine were used together. The authors discuss how the two treatments may have complementary antidepressant mechanisms and call for further research on the combination's feasibility, tolerability, and efficacy.
For people with treatment-resistant depression who did not benefit from transcranial magnetic stimulation (TMS), intravenous racemic ketamine may offer some help. In a small case series of 21 patients, a course of six ketamine infusions over two weeks was safe and produced few side effects. Average depression scores, measured by the MADRS scale, fell from 27.6 (moderate depression) to 18.6 (mild depression), a mean improvement of 34.5%. Four patients (19%) responded to treatment, and two of those (9.5%) achieved remission. The study was uncontrolled and retrospective, so results are preliminary.