Interventional Options for TRD: ECT, TMS, and Esketamine

In this episode, ‘Interventional Options for TRD: ECT, TMS, and Esketamine,’ the expert psychiatrist explores the following questions:

What interventional options are currently available for treatment-resistant depression, from structured programs to electroconvulsive therapy, transcranial magnetic stimulation, ketamine, and esketamine?

How do clinicians and patients with treatment-resistant depression choose among these interventions?

The expert psychiatrist examined structured programs such as inpatient, partial hospitalization, and intensive outpatient care, then described how electroconvulsive therapy and transcranial magnetic stimulation work. He noted that ECT remains underused because of stigma, while TMS helps roughly 40% to 60% of patients and fits into a standard workday with few adverse effects. He introduced ketamine’s low-dose mechanism, which drives glutamate release and brain-derived neurotrophic factor, and esketamine’s 2019 FDA approval for TRD and for major depressive disorder with suicidal features, which brought broader insurance coverage. He emphasized that patient preference, cost, transportation, and time away from work guide the final choice.

Throughout the conversation, the experts provide a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

The next episode in this series, ‘Esketamine in TRD: The Evidence Base and the Cost Critique,’ features the expert advancing the conversation on treatment-resistant depression and focusing on the trials behind esketamine and how he responds to arguments favoring racemic ketamine.