Patients' recovery and non-recovery narratives after intravenous ketamine for treatment-resistant depression.
Adrienne Lapidos, Daniela Lopez-Vives, Cortney E. Sera, Elizabeth Ahearn, Erica Vest, Ivana Senic, J. V. Vande Voort, M. Frye, Fernando S. Goes, Eric D. Achtyes, J. Greden, S. Parikh
Journal of Affective Disorders December 1, 2022 DOI: 10.1016/j.jad.2022.11.090 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Qualitative study Peer reviewed |
|---|---|
| Sample size | 21 |
| Population | Adults with treatment-resistant depression |
| Intervention | Intravenous ketamine |
| Duration | Three infusions over a two-week period; outcomes assessed 24 hours after the third infusion |
| Topics | Depression Esketamine Ketamine |
| Key findings | Of 21 adults with treatment-resistant depression receiving three IV ketamine infusions, 9 (43%) remitted and 12 (57%) did not, yet 5 non-remitters reported partial recovery and substantial subjective benefit. Participants attributed ketamine's effects to biological and experiential mechanisms. The authors propose that preparatory support addressing multiple recovery pathways, decoupling the psychedelic experience from outcomes, and managing disappointment may benefit patients, while noting these suggestions require confirmation. |
Abstract
Background: Intravenous (IV) ketamine is an effective therapy for treatment-resistant depression. A large data base is confirmatory and steadily expanding. Qualitative studies can inform best practices and suggest new research directions. As part of a clinical trial designed to identify biomarkers of ketamine response, a qualitative study was conducted to characterize experiences with: receiving infusions; recovering or not recovering from depression; and beliefs about why ketamine worked or did not work.
Methods: Adults with treatment-resistant depression received three IV ketamine infusions in a two-week period and were characterized as remitters or non-remitters via symptom reduction 24 h after the third infusion. Qualitative interviews of a subset of participants were audio recorded, transcribed verbatim, and coded using deductive and inductive methods. Themes were derived and compared across a broader construct of recovery status.
Results: Of the 21 participants, nine (43 %) were characterized as having experienced remission and 12 (57 %) non-remission. Of the 12 non-remitters, five were characterized as having experienced partial recovery based on their subjective experiences, reporting substantial benefit from ketamine infusions despite non-remission status based on scale measurements. Attributions for ketamine's effects included biological and experiential mechanisms. Among non-remitters there was risk of disappointment when adding another failed treatment.
Limitations: A more diverse sample may have yielded different themes. Different patients had different amounts of time elapsed between ketamine infusions and qualitative interview.
Conclusions: Qualitative methods may enhance researchers' characterization of IV ketamine's impact on treatment-resistant depression. While requiring confirmation, patients may benefit from a preparatory milieu that prepares them for multiple recovery pathways; decouples the psychedelic experience from clinical outcomes; and addresses potential risks of another failed treatment.