Combining Ketamine With Behavioural Activation Therapy for Treatment-Resistant Depression

Trial details

Who runs it

The Royal's Institute of Mental Health Research

Trial code

NCT07801703

Record updated

9 November 2026

Original description

The goal of this clinical trial is to see if combining ketamine with behavioral activation (BA) therapy to treat moderate to severe treatment-resistant depression improves depressive symptoms and general functioning more than ketamine alone.Read full original descriptionShow less

Optimizing the Synergy Between Behavioural Activation Therapy and Intravenous Ketamine for Treatment-Resistant Depression

The goal of this clinical trial is to see if combining ketamine with behavioral activation (BA) therapy to treat moderate to severe treatment-resistant depression improves depressive symptoms and general functioning more than ketamine alone.

We aim to find out whether participants who receive both treatments:

1. Have greater reductions in depression symptoms than those who receive ketamine only 2. Have better response and remission rates than those who receive ketamine only 3. Experience better overall functioning, including mood, anxiety, quality of life, and physical activity than those who receive ketamine only

Participants will be randomized to one of two groups: Arm 1) concurrent ketamine and BA therapy started from treatment initiation, or Arm 2) ketamine treatment alone.

* All participants will undergo IV ketamine infusions administered twice weekly for three weeks. * Half of the participants in will also undergo BA therapy sessions twice weekly for three weeks. * Individuals with a sufficient treatment response after 3 weeks will proceed to undergo an additional 12 weeks of ketamine infusions (and those receiving BA therapy will continue to receive therapy for an additional 12 weeks).

Inclusion: English speaking; Age 18-65 at Screening; Meeting criteria for major depressive disorder (MDD), in a major depressive episode without psychotic symptoms according to the Diagnostic and Statistical Manual for Mental Disorders (DSM-5); Have not responded adequately to at least two separate courses of treatment with different antidepressants, each of adequate dose and duration, in the current depressive episode; Currently in a moderate to severe depressive episode, with a minimum MADRS score of ≥22 at Screening; Be under the care of a designated health care provider (e.g., family physician or psychiatrist) to follow their care after the completion of the study; Willing to maintain stable doses of concomitant psychotropic medications throughout the study; Willing to abstain from taking prohibited medications on the days of treatment (i.e., for 12 hours prior to treatment) as per study physician instruction (e.g., benzodiazepines, cannabis); Able to secure a ride/chaperone home from all ketamine infusions.

Exclusion: Concurrent use of ketamine or psychedelics in any form; A previous history or known diagnosis of major neurocognitive disorder; Concurrent psychotherapy treatment outside the clinical trial. A participant may opt to pause or terminate their current ongoing psychotherapy to participate in the study, at their own discretion; Concurrent active electroconvulsive therapy (ECT) or repetitive transcranial magnetic stimulation (rTMS) therapy; Depression secondary to a stroke, cancer, or other clinically significant medical illness, per study physician judgement; Not medically cleared to receive ketamine treatment due to presence of clinically relevant disease, per study physician judgement (e.g., uncontrolled hypertension, renal or hepatic impairment, significant coronary artery disease, vascular disease, diabetes mellitus, seizure disorder, intracerebral hemorrhage, history of cerebrovascular accident [CVA]); Current and/or recent history (<12 months) of substance use disorder/dependence (except for alcohol, cannabis, caffeine or nicotine) as defined by DSM-5 criteria; Current and/or recent history (<6 months) of cannabis use disorder as defined by DSM-5 criteria, or unable to abstain from using cannabis 12 hours before and 12 hours after each ketamine infusion; Current and/or recent history (<6 months) of alcohol use disorder as defined by DSM-5 criteria, or unable to abstain from using alcohol 12 hours before and 12 hours after each ketamine infusion; Known or suspected history of intolerance, allergy or hypersensitivity to ketamine; Any other condition or circumstance that, in the opinion of the QI/study physicians, would adversely affect the participant's ability to complete the study procedures or its measures; Pregnant, breastfeeding or of childbearing potential and unwilling to use an approved method of contraception during the study, as assessed during the Screening Visit medical clearance; History of a primary psychotic disorder (e.g., schizophrenia), or current or recent (<2 years) acute episode of psychosis; Body mass index (BMI) ≥35.

ClinicalTrials.gov NCT07801703