Major depressive disorder (MDD) is common and carries a high suicide risk. Electroconvulsive therapy (ECT) is highly effective but limited by adverse effects; ketamine/esketamine can boost ECT's efficacy and safety but have their own side effects. Binaural beat music (BBM), a non-invasive therapy, may improve mood and assist (es)ketamine. This 2×2 factorial, randomized, blinded clinical trial recruits 476 MDD patients requiring ECT, randomly assigned to four groups: blank sound with saline, blank sound with esketamine, BBM with saline, or BBM with esketamine. The primary outcome is response rate measured by the Hamilton depression scale; secondary outcomes include remission, suicidal ideation, cognitive function, and side effects. The data are expected to show BBM's potential for optimizing ECT strategies and improving patient outcomes.
Miscarriage and the subsequent curettage procedure increase risks of depression, anxiety, and insomnia. Ketamine and its derivative esketamine can prevent postpartum depression and treat depressive symptoms after miscarriage curettage, but side effects limit their use. Ascorbic acid (vitamin C) may enhance esketamine's antidepressant effects while reducing its dosage and adverse effects. This 2×2 factorial, double-blinded, randomized controlled trial will recruit 424 women with miscarriage undergoing painless curettage, allocating them equally to four groups: placebo, esketamine alone, vitamin C alone, or vitamin C plus esketamine.