Burnout Symptom Outcomes During At-Home Ketamine-Assisted Therapy: A Real-World Retrospective Analysis of 395 Adults

Abstract Background Occupational burnout, recognized in ICD-11 as an occupational phenomenon, is a syndrome of chronic workplace stress comprising emotional exhaustion, cynicism (the analogue of the depersonalization dimension on the MBI-Human Services Survey form), and reduced professional efficacy on the Maslach Burnout Inventory-General Survey (MBI-GS). Burnout is common among US working adults; in a probability-based national sample, 25.2% reported burnout symptoms in 2020 (28.1% in 2017), measured with items from the Maslach Burnout Inventory. Established interventions for burnout include mindfulness-based interventions, third-wave cognitive-behavioral therapy, organizational interventions, and behavioral interventions. Ketamine, a non-competitive N-methyl-D-aspartate receptor antagonist, has rapid antidepressant effects and preclinical evidence of pro-resilience effects on chronic-stress models.

Objective: This exploratory, hypothesis-generating analysis describes self-reported burnout symptom outcomes, as measured by the three MBI-GS subscales and the published five-profile Maslach typology, among adults with elevated baseline burnout who completed at-home ketamine-assisted therapy through Mindbloom, a telehealth ketamine therapy platform.

Methods: We conducted a retrospective analysis of 395 adults with elevated baseline MBI-GS burnout (a moderate-or-higher operational threshold defined as Exhaustion ≥ 4.8 and either Cynicism ≥ 3.8 or Professional Efficacy ≤ 4.3) who completed all four scheduled MBI-GS assessments (baseline, post-session 2, post-session 4, and post-session 6) during enrollment in Mindbloom's at-home ketamine-assisted therapy program. Depression was the primary indication for treatment in this cohort and was present as a frequent comorbidity; burnout symptoms were assessed as a co-occurring dimension at the same timepoints. Burnout was characterized using the three MBI-GS subscales separately and the published five-profile Maslach typology (Engaged, Overextended, Disengaged, Ineffective, Burnout). Following the MBI-GS scoring manual (Mind Garden, Maslach et al., 4th ed., 2018), no aggregate composite burnout score is reported.

Results: Among the completers classified with full Burnout (the most severe Maslach profile) at baseline, 76.1% (95% Wilson CI 65.0–84.5%) achieved operational-threshold remission of the full Burnout classification at post-session 6. Of 1,642 participants who initiated treatment with a baseline MBI-GS meeting the moderate-or-higher burnout threshold, 395 (24.1%) completed the full six-session protocol with all four MBI-GS assessments. The proportion of completers classified as Engaged (the non-burned-out profile) grew from 16.7% at baseline to 49.4% at post-session 6 (a 2.95-fold increase). Subscale-level study-defined response (≥ 1-point improvement) was achieved by 55.4% on Exhaustion (95% CI 50.5–60.3%), 48.9% on Cynicism (44.0–53.8%), and 26.3% on Professional Efficacy (22.2–30.9%). Paired within-subject Cohen's d_z values were 0.95 on Exhaustion, 0.73 on Cynicism, and 0.20 on Professional Efficacy. Considered jointly across the three subscales, 69.6% of completers improved by at least 1 point on at least one dimension. 59.5% of completers achieved operational-threshold remission below the moderate-or-higher cohort-eligibility threshold at post-session 6. Side effects of any type were reported by 3.5% to 4.3% of completers across timepoints.

Conclusions: In this completer cohort, 76.1% of patients classified with full Burnout at baseline no longer met that classification at post-treatment, the Engaged classification grew nearly threefold, and within-subject standardized change was largest on the Exhaustion and Cynicism subscales. Because depression and burnout co-occur frequently and share substantial symptom overlap on validated instruments, the burnout-specific contribution of ketamine cannot be isolated from concurrent mood changes in this uncontrolled design; randomized controlled trials are needed to confirm these findings.