University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository




Nancy Reid, DHSc, PA-C


The purpose of this article is to review published trials and reviews regarding the current treatment for treatment-resistant depression (TRD) and examine whether ketamine is more efficacious in treating TRD compared to electroconvulsive therapy (ECT). This article aims to establish: (1) the most effective dose of ketamine to achieve remission from TRD, (2) the frequency with which to administer ketamine, (3) the implications and risks of long-term use of ketamine for TRD, and (4) evaluate whether ketamine is more effective than ECT for TRD. A PubMed literature search was conducted with search terms “depression,” “ketamine,” “ECT,” “electroconvulsive therapy,” “major depressive disorder,” and “major depression.” Results of the search were filtered to only include articles published within the last five years. Of the 37 articles that were retrieved, 18 were pertinent and serve as the basis for this clinical review. Ketamine infusion therapy involves administration of racemic ketamine at 0.5 mg/kg sub-anesthetic doses over 40-45 minutes. Results from studies have shown significant reduction in symptoms of depression and TRD with more rapid onset compared to ECT. Preliminary results from studies completed thus far suggest that ketamine is at least non-inferior to ECT for the treatment of MDD and TRD. Researchers have identified the value of ketamine for highly acute and severely ill patients due to its rapid onset of action. Further research is required to provide more robust evidence to support preliminary findings.


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