Holding on or letting go? Patient experiences of control, context, and care in oral esketamine treatment for treatment-resistant depression: A qualitative study.
Joost J. Breeksema, Alistair Niemeijer, Bouwe Kuin, Jolien K E Veraart, Jeanine Kamphuis, Nina Schimmel, Wim van den Brink, Eric Vermetten, Robert A Schoevers
Frontiers in Psychiatry 2022 DOI: 10.3389/fpsyt.2022.948115 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Qualitative study Peer reviewed |
|---|---|
| Sample size | 17 |
| Population | Patients with treatment-resistant depression participating in off-label oral esketamine treatment |
| Intervention | oral esketamine |
| Duration | Six-week, twice-weekly esketamine treatment program, subsequently after six months of at-home use |
| Topics | Esketamine Ketamine Philosophy of mind Depression |
| Keywords | Patient experience Set and setting Treatment-resistant depression trd Refractory depression Therapy-resistant depression Psychedelic medicine Psychedelic treatment Esketamine ketamine Sp |
| Citations | 41 |
| Key findings | Patients' ability to let go during esketamine sessions is influenced by preparation, emotional support, and setting, which may affect mood and treatment outcomes. |
Abstract
Ketamine and its enantiomer esketamine represent promising new treatments for treatment-resistant depression (TRD). Esketamine induces acute, transient psychoactive effects. How patients perceive esketamine treatment, and which conditions facilitate optimal outcomes, remains poorly understood. Understanding patient perspectives on these phenomena is important to identify unmet needs, which can be used to improve (es)ketamine treatments. To explore the perspectives of TRD patients participating in "off label" oral esketamine treatment. In-depth interviews were conducted with 17 patients (11 women) after a six-week, twice-weekly esketamine treatment program, and subsequently after six months of at-home use. Interviews explored participants' perspectives, expectations, and experiences with esketamine treatment. Audio interviews were transcribed verbatim and analysed following an Interpretative Phenomenological Analysis (IPA) framework. Key themes included overwhelming experiences; inadequate preparation; letting go of control; mood states influencing session experiences; presence and emotional support, and supportive settings. Patients' attempts to let go and give into vs. attempts to maintain control over occasionally overwhelming experiences was a central theme. Multiple factors influenced patients' ability to give into the experience and appeared to impact their mood and anxiety about future sessions, including level of preparation and education, physical and emotional support, and setting during the session. Better preparation beforehand, an optimized treatment setting, and emotional and psychological support during (es)ketamine sessions can help patients to "let go" and may lead to better quality of care and outcomes. Recommendations to improve quality of patient care in (es)ketamine treatment are provided, including suggestions for the training of nurses and other support staff.
Comparable studies
Other qualitative studies on esketamine for depression, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Phenomenology and therapeutic potential of patient experiences during oral esketamine treatment for treatment-resistant depression: an interpretative phenomenological study. Patients with treatment-resistant depression undergoing oral esketamine treatment | 2023 | Qualitative study using Interpretative Phenomenological Analysis | n = 17 |
| Narrative Experiences of Esketamine-Induced Dissociation in Patients with Treatment-Resistant Depression: A Qualitative Exploratory Study Adults with treatment-resistant depression receiving intranasal esketamine in... | 2026 | Qualitative exploratory study | n = 36 |
| Person-centred care during treatment with nasal esketamine - a qualitative study. Patients with treatment-resistant depression who had received at least eight treatments... | 2025 | Qualitative study | n = 20 |
| Like Stepping Outside the Noise: Narrative Experiences of Esketamine-Induced Dissociation in Patients with Treatment-Resistant Depression Patients with treatment-resistant depression treated with intranasal esketamine in... | 2026 | Qualitative study | n = 36 |
Citations in the library
Cited by 37
- Patient perspectives and experiences with psilocybin treatment for treatment-resistant depression: a qualitative study Scientific Reports February 5, 2024
- Phenomenology and therapeutic potential of patient experiences during oral esketamine treatment for treatment-resistant depression: an interpretative phenomenological study. Psychopharmacology July 1, 2023
- At-home, telehealth-supported ketamine treatment for depression: Findings from longitudinal, machine learning and symptom network analysis of real-world data. Journal of Affective Disorders September 15, 2024
- Patient Experience with Intranasal Esketamine in Treatment-Resistant Depression: Insights from a Multicentric Italian Study (REAL-ESKperience) Journal of Personalized Medicine April 1, 2025
- ‘Mind-Revealing’ Psychedelic States: Psychological Processes in Subjective Experiences That Drive Positive Change Psychoactives September 27, 2024
and 32 more in the library
Cites 40
- Human hallucinogen research: guidelines for safety. Journal of Psychopharmacology July 1, 2008
- Quality of Acute Psychedelic Experience Predicts Therapeutic Efficacy of Psilocybin for Treatment-Resistant Depression Frontiers in Pharmacology January 17, 2018
- Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation American Journal of Psychiatry March 17, 2021
- Psychedelics and the essential importance of context. Journal of Psychopharmacology February 15, 2018
- Global Street Food: la cocina de la calle Diseño interior 2009
and 35 more in the library