Mystical experiences, which may have therapeutic value, occurred in about 17-18% of ketamine treatments among 60 veterans with treatment-resistant depression. In those receiving esketamine, more treatment sessions were linked to higher mystical experience scores; in those receiving racemic ketamine, higher doses were linked to higher scores. The findings suggest that ketamine can occasion mystical experiences in this population.
A brief mobile version of the Mantram Repetition Program (mMRP), a meditation-focused approach, was tested with 36 veterans who had significant PTSD symptoms. Participants completed four weekly video modules and used their mantram 4 to 5 days per week. The program was rated as acceptable, appropriate, and feasible. PTSD symptoms and general health improved from before to after the program, but depression and insomnia did not change significantly. Adding text message support did not improve outcomes over self-directed use; support was mostly used for administrative needs. Veterans suggested adding more guidance on using the skills and alternative support options. The findings indicate that mMRP can be delivered briefly and that veterans learn and use the technique.
Intramuscular (IM) ketamine is as effective as intranasal (IN) esketamine for treatment-resistant depression, with comparable safety and a dramatically lower cost. In a retrospective cohort of 179 Veterans, the difference in depression symptom improvement was only 0.04 points on the PHQ-9, well within the non-inferiority margin. PTSD symptom reductions were also similar, and rates of emergency department visits or hospitalizations did not differ significantly. The cost per eight-treatment course was $6069 for IN esketamine versus $647 for IM ketamine, driven primarily by the cost of the nasal spray. These results indicate that IM ketamine could be a high-value alternative that expands access to care.