Crook - SO glad you had your doctor visit and happy that you have options. Not that any option appears ideal, but at least there are options. . .

I know next to nothing about the ketamine therapy, but some other PC forum members are currently discussing it: http://forums.psychcentral.com/other...epression.html
How long is the trial? How long are anticipated effects to last once a patient has their last trial treatment? I'm wondering if that by the time your trial ends, and if it is successful and is something you'd want to continue, that it could be available in your area by then? Also, here is a link of providers that you could check from time-to-time:
Ketamine Advocacy Network - Provider Directory Note that as this site states that this may not be a full listing of providers, so there could be some closer than you realize.

ECT . . . well, how has it worked for you in the past? If this is something that you generally respond well to, then I definitely think it is worth considering. No one wants a stay in the hospital, but if this option gets you to a safe and productive place and the positive results can transpire relatively quickly it may be quite worth it. My thought from my own perspective is that if you find yourself in the position of going inpatient, then may as well pick the most effective treatment, short and long-term, don't fight it while there, and just get it over-and-done-with. (It's not that simplistic for you, I'm sure, but framing things in such a core, simplistic way for myself is extremely effective. It feels better to make a reasoned choice than getting stuck in place of endless questioning.)

For me, I would think I would be open to an MOAI or other Rx, but only after I stabilized. The key thing for you is to stabilize, to live and to be engaged with your family, job, and life - Step 1. But, I would consider switching drugs as Step 2, and I would not blow it off after the crisis passes.

Hopefully, some others can chip in with some thoughts.