This study aimed to compare the efficacy, safety, and tolerability of electroconvulsive therapy (ECT) versus intravenous (IV) ketamine in adults with treatment-resistant major depressive disorder (TRD).

Treatment resistant depression is defined as a lack of adequate response to at least two antidepressant trials of sufficient dose, duration, and adherence in the current depressive episode.

Recent studies estimate treatment-resistant depression (TRD) by 30% of people with major depressive disorder (MDD) leading to significant challenges in care. This condition can increase disability, healthcare costs, and suicide risk, making effective treatments crucial.

Inclusion Criteria:

• Adults aged 18-75 years.
• Current diagnosis of major depressive disorder (MDD) according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria.
• Treatment resistance defined as failure to respond to ≥2 adequate antidepressant trials in the current episode.
• Montgomery-Åsberg Depression Rating Scale (MADRS) score ≥20.
• Capacity to provide informed consent.

Exclusion Criteria:

• History of psychotic disorders or bipolar disorder.
• Current substance use disorder.
• Significant neurological disorders or traumatic brain injury.
• Uncontrolled hyper- tension.
• cardiovascular diseases in the past six months.
• Pregnancy or breastfeeding.

The data will be available upon a reasonable request from the corresponding author after the end of study for one year.

After the end of study for one year.

The data will be available upon a reasonable request from the corresponding author.