ECT With Ketamine Anesthesia vs High Intensity Ketamine With ECT Rescue for Treatment-Resistant Depression

This randomised, parallel trial evaluates whether an intensive daily IV ketamine regimen with ECT rescue (HIKER) hastens remission, reduces side effects and need for ECT, and is preferred by patients compared with standard ECT with ketamine-based general anaesthesia (EAST).

HIKER participants receive IV ketamine 0.50 mg/kg on eight successive weekdays; non-responders after three treatments are switched to an eight-session course of ECT under ketamine anaesthesia. EAST participants receive eight ECT treatments with ketamine 0.75 mg/kg plus remifentanil and succinylcholine as needed. Primary outcomes focus on speed of remission and safety/tolerability.