Rapid Relief of Treatment Resistant Depression by Facilitated Ketamine Infusion: A Preliminary Report

Steven R. Devore Best


By combining transcranial magnetic stimulation (TMS) with intravenous ketamine therapy, we sought to increase the therapeutic value of TMS and, at the same time, to improve the efficacy of intravenous ketamine therapy among depressed patients previously classified as non-responders. In this preliminary report, we provide evidence for a new and much more reliable method of treating patients with treatment resistant depression. Twenty-eight patients with various degrees of treatment unresponsive depression were treated with a combination of TMS and ketamine infusion. Of these patients, twenty received pretreatment for 3 days to 2 weeks involving intensive (thrice daily) rTMS treatment administered 6 or 7 days/week or priming TMS treatment immediately prior to the combination TMS-ketamine infusion combination therapy. Eight patients received neither pretreatment nor priming. All of the 28 patients who did fully participate in the first month of treatment experienced relief of psychiatric symptoms, and showed significant psychosocial recovery. In contrast to previous studies examining ketamine or rTMS individually, the positive outcomes presented here suggest a synergistic effect of the combination therapy of TMS and ketamine infusion.

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