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Ketamine treatment for individuals with treatment-resistant depression: longitudinal qualitative interview study of patient experiences

Karen Lascelles, Lisa Marzano, Fiona Brand, Hayley Trueman, Rupert McShane, Keith Hawton

BJPsych Open 2021 DOI: 10.1192/bjo.2020.132 (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Qualitative study Longitudinal Peer reviewed
Sample size 12
Population Fee-paying patients with treatment-resistant depression (ages 21–70, 6 females, 6 males, 11 reporting suicidality, 6 reporting self-harm)
Intervention Ketamine treatment
Duration Up to 2 months or longer follow-up
Topics Depression Esketamine Ketamine
Citations 20
Key findings Ketamine treatment provided short-term mood improvement and reduced suicidal ideation for most patients, but longer-term benefit was limited and the transient nature of improvement, along with cost, posed challenges.

Abstract

BackgroundKetamine has recently received considerable attention regarding its antidepressant and anti-suicidal effects. Trials have generally focused on short-term effects of single intravenous infusions. Research on patient experiences is lacking.AimsTo investigate the experiences over time of individuals receiving ketamine treatment in a routine clinic, including impacts on mood and suicidality.MethodTwelve fee-paying patients with treatment-resistant depression (6 females, 6 males, age 21–70 years; 11 reporting suicidality and 6 reporting self-harm) who were assessed as eligible for ketamine treatment participated in up to three semi-structured interviews: before treatment started, a few weeks into treatment and ≥2 months later. Data were analysed thematically.ResultsMost participants hoped that ketamine would provide respite from their depression. Nearly all experienced improvement in mood following initial treatments, ranging from negligible to dramatic, and eight reported a reduction in suicidality. Improvements were transitory for most participants, although two experienced sustained consistent benefit and two had sustained but limited improvement. Some participants described hopelessness when treatment stopped working, paralleled by increased suicidal ideation for three participants. The transient nature and cost of treatment were problematic. Eleven participants experienced side-effects, which were significant for two participants. Suggestions for improving treatment included closer monitoring and adjunctive psychological therapy.ConclusionsKetamine treatment was generally experienced as effective in improving mood and reducing suicidal ideation in the short term, but the lack of longer-term benefit was challenging for participants, as was treatment cost. Informed consent procedures should refer to the possibilities of relapse and associated increased hopelessness and suicidality.

Comparable studies

Other qualitative studies on ketamine for depression, most cited first.

Study Year Design Participants
Ketamine for Depression, 4: In What Dose, at What Rate, by What Route, for How Long, and at What Frequency? 2017 Qualitative review
Holding on or letting go? Patient experiences of control, context, and care in oral esketamine treatment for treatment-resistant depression: A qualitative study. Patients with treatment-resistant depression participating in off-label oral esketamine... 2022 Qualitative study n = 17
A Cohort-Based Case Report: The Impact of Ketamine-Assisted Therapy Embedded in a Community of Practice Framework for Healthcare Providers With PTSD and Depression Healthcare providers 2022 Quality improvement evaluation with mixed methods n = 94
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
A qualitative study of patients' experience of ketamine treatment for depression: The ‘Ketamine and me’ project Patients diagnosed with treatment resistant depression (TRD) with experience of... 2021 Qualitative study n = 13

Citations in the library

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Depression Esketamine Ketamine

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Ketamine for depression