Clinician-patient communication in esketamine and psychedelic-assisted treatments for depression: a scoping review of evidence, gaps, and clinical implications
Study at a glance
AI-extracted from the abstract| Characteristics | Scoping review protocol |
|---|---|
| Interventions | Esketamine Psilocybin MDMA |
| Topics | Depression Esketamine |
| Key findings | The authors anticipate identifying a marked asymmetry between the structured communication frameworks developed for psychedelic-assisted therapies and the largely implicit communicative infrastructure of esketamine administration. They argue that no systematic or scoping review has yet examined communication practices across these consciousness-altering treatments in a comparative framework. |
Abstract
Background: Treatment-resistant depression (TRD) affects approximately one-third of patients with major depressive disorder and represents a critical clinical challenge. Esketamine (S-ketamine, Spravato), approved by FDA and EMA since 2019, and psychedelic-assisted therapies (psilocybin, MDMA) share a pharmacological feature unique among approved psychiatric treatments: they induce altered states of consciousness during administration. This creates specific and unaddressed challenges for clinician-patient communication — from initial treatment proposal and informed consent to preparation, intra-session monitoring, post-session integration, and long-term adherence. Despite growing clinical and research interest, no systematic or scoping review has examined communication practices across these treatments in a comparative framework.
Objectives: This scoping review aims to: (1) systematically map existing evidence on clinician-patient communication across phases of esketamine and psychedelic-assisted treatments; (2) characterise informed consent practices; (3) examine the role of therapeutic alliance, preparation, and integration; (4) compare communication frameworks between esketamine and psychedelic-assisted therapy; (5) identify barriers and facilitators to treatment initiation and adherence; (6) propose directions for future research and clinical guidelines.
Methods: Scoping review following Arksey & O'Malley (2005)/Levac et al. (2010), reported according to PRISMA-ScR (Tricco et al., 2018). Searches: PubMed/MEDLINE and Scopus. No restrictions on study design, date, or substance route. Data synthesis: thematic narrative synthesis across six a priori domains. Two independent reviewers for all screening phases. EXPECTED
Outcomes: We anticipate identifying a marked asymmetry between the structured communication frameworks developed for psychedelic-assisted therapies and the largely implicit communicative infrastructure of esketamine administration. Findings will inform clinical practice and future research on patient-centred approaches to consciousness-altering pharmacotherapies.