A 48-year-old man without prior medical history developed a paranoid psychosis with visual and auditory hallucinations that lasted five days after eating Amanita muscaria mushrooms, which he mistook for edible A. caesarea. The typical duration of symptoms from this mushroom is under 24 hours, but in this case psychosis appeared 18 hours after ingestion and persisted for five days before gradually resolving. One year later the man had no symptoms of psychiatric disease and was not undergoing therapy.
Modern electroconvulsive therapy (ECT) and nasal esketamine have significantly improved treatment for treatment-resistant depression (TRD), defined as non-response to at least two adequate antidepressant courses. This literature review presents evidence on efficacy and safety, comparing advantages, disadvantages, and response rates. Both treatments are highly effective for TRD. The choice between esketamine nasal spray and ECT should consider contraindications, age, severity, psychotic symptoms, patient preference, and accessibility. Pragmatically, esketamine is chosen before ECT when both are indicated, but studies on ECT in ketamine non-responders are missing.