Phenomenology and therapeutic potential of patient experiences during oral esketamine treatment for treatment-resistant depression: an interpretative phenomenological study.
Joost J. Breeksema, Alistair Niemeijer, Bouwe Kuin, Jolien K E Veraart, Eric Vermetten, Jeanine Kamphuis, Wim van den Brink, Robert A Schoevers
Psychopharmacology July 1, 2023 DOI: 10.1007/s00213-023-06388-6 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Qualitative study using Interpretative Phenomenological Analysis Peer reviewed |
|---|---|
| Sample size | 17 |
| Population | Patients with treatment-resistant depression undergoing oral esketamine treatment |
| Intervention | oral esketamine |
| Dose | 0.5-3.0mg/kg |
| Duration | 6-week, twice-weekly treatment program |
| Topics | Depression Esketamine Philosophy of mind Psychedelic-assisted therapy |
| Keywords | Patient experiences Psychotherapy Qualitative research Mental health treatment |
| Citations | 26 |
| Key findings | Esketamine experiences are highly variable and often distressing, but some effects like openness and detachment may have psychotherapeutic potential. |
Abstract
Ketamine and its enantiomers are widely researched and increasingly used to treat mental disorders, especially treatment-resistant depression. The phenomenology of ketamine-induced experiences and their relation to its psychotherapeutic potential have not yet been systematically investigated. To describe the phenomenology of patient experiences during oral esketamine treatment for treatment-resistant depression (TRD) and to explore the potential therapeutic relevance of these experiences. In-depth interviews were conducted with 17 patients after a 6-week, twice-weekly 'off label' generic oral esketamine (0.5-3.0mg/kg) treatment program. Interviews explored participants' perspectives, expectations, and experiences with oral esketamine treatment. Audio interviews were transcribed and analyzed using an Interpretative Phenomenological Analysis (IPA) framework. The effects of ketamine were highly variable, and psychological distress was common in most patients. Key themes included (a) perceptual effects (auditory, visual, proprioceptive), (b) detachment (from body, self, emotions, and the world), (c) stillness and openness, (d) mystical-type effects (transcendence, relativeness, spirituality), and (e) fear and anxiety. Key themes related to post-session reports included (a) feeling hungover and fatigued, and (b) lifting the blanket: neutralizing mood effects. Patients reported several esketamine effects with psychotherapeutic potential, such as increased openness, detachment, an interruption of negativity, and mystical-type experiences. These experiences deserve to be explored further to enhance treatment outcomes in patients with TRD. Given the frequency and severity of the perceived distress, we identify a need for additional support in all stages of esketamine treatment.