Randomised, parallel-group trial (n=62) comparing high-intensity daily IV ketamine (0.50 mg/kg for 8 days; HIKER) versus ECT with ketamine anaesthesia (EAST; 8 sessions) 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.
High Intensity Ketamine (HIKER): daily IV ketamine 0.50 mg/kg for 8 successive weekdays; non-responders after 3 treatments receive rescue ECT.
Single IV infusion per day; non-responders after 3 treatments switched to rescue ECT.
ECT with ketamine-based general anaesthetic (EAST): eight ECT sessions (2–3/week) with ketamine 0.75 mg/kg plus remifentanil and succinylcholine as needed.
Ketamine as primary anaesthetic
Remifentanil (1 µg/kg) to reduce discomfort; dose titrated by anaesthesiologist
Succinylcholine 0.75 mg/kg for safety; anaesthesiologist may vary doses or add propofol as needed
ECT procedure: unilateral or bilateral electrode placement with seizure threshold monitored by half-age method