Combined treatment with intranasal esketamine and electroconvulsive therapy in resistant depression. Two cases report

Introduction Depressive symptoms that do not respond to 2 lines of antidepressant treatment in adequate doses for 6-8 weeks are known as resistant depression. As therapeutic alternatives we currently have, among other options, intranasal esketamine and electroconvulsive therapy (ECT). Objectives To present two cases of resistant depression in combined treatment with esketamine and ECT as an effective tratment Methods 2 cases report Results The first one is a 60-year-old male with a diagnosis of recurrent depression who was admitted after an autolytic attempt by drug overdose. Our second patient is a 59-year-old male with a diagnosis of bipolar disorder, current major depressive episode with psychotic symptoms. He had a history of previous depressive episodes, requiring treatment with ECT on 2 occasions due to resistance to psychopharmacological treatment. Both patients had major depressive symptoms resistant to conventional pharmacological treatment, with a predominance of sadness, apathy, anhedonia, hopelessness, psychomotor inhibition and self-induced suicidal ideation. One of them also presented psychotic symptoms congruent with mood. The first patient received treatment with intranasal esketamine with partial response, so a combination with ECT was started once the 8 biweekly sessions of the induction phase were completed. The second patient was initially ambivalent to a new cycle of ECT. For this reason, treatment with esketamine was proposed and after 6 biweekly sessions he agreed to overlap treatment with ECT. In both patients there was a clear improvement in clinical symptoms and adequate tolerability, allowing discharge home. Conclusions There are few data in the literature on combined treatment with intranasal esketamine and ECT. Our experience in the 2 cases described points to an adequate response and tolerability. Specific studies would be necessary in this regard. Disclosure of Interest None Declared