Choosing Treatment for Difficult Depression

PsychopharmaPearls is NEI's focused podcast series highlighting the clinical insights that can sharpen your prescribing decisions. In this episode, Dr. Andy Cutler talks with Dr. Lisa Harding about how to choose between IV ketamine and intranasal esketamine for patients with difficult-to-treat depression. They unpack the differences that truly matter in practice—from patient selection and monitoring to access, cost, and common missteps. Tune in for practical pearls you can immediately apply to select the right treatment for the right patient.

Lisa Harding, MD is a board-certified psychiatrist and nationally recognized depression specialist with deep expertise in interventional psychiatry. She has performed more than 4,000 procedures, including electroconvulsive therapy (ECT), intravenous ketamine, intranasal esketamine, and transcranial magnetic stimulation (TMS). Dr. Harding is known for her thoughtful approach to complex, treatment-resistant depression, integrating advanced somatic therapies, psychopharmacology, and psychotherapy. She serves as an Assistant Clinical Professor of Psychiatry at Yale University in New Haven, Connecticut.

Andrew J. Cutler, MD is a leading psychiatrist, psychopharmacology expert, and clinical researcher with decades of experience in CNS drug development. As Chief Medical Officer of Neuroscience Education Institute and EMA Wellness, he brings frontline clinical insight together with deep knowledge of the evidence base. Dr. Cutler is widely recognized for translating research into practical guidance for everyday practice and serves as a Clinical Associate Professor of Psychiatry at SUNY Upstate Medical University in Syracuse, New York.

Resources

Sanacora G et al. A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders. JAMA Psychiatry 2017;74(4):399-405. doi:10.1001/jamapsychiatry.2017.0080

McIntyre RS et al. Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation. Am J Psychiatry 2021;178(5):383-399. doi:10.1176/appi.ajp.2020.20081251

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