Feasibility and tolerability of virtual reality during esketamine treatment: A pilot study.

Abstract

Ketamine/esketamine produce rapid antidepressant effects, with growing interest in how acute subjective experiences and the surrounding set and setting shape clinical outcomes. Little is known about how audiovisual adjustments during ketamine/esketamine treatment influence comfort, tolerability, or patient experience, despite their common use in clinical practice. Virtual reality (VR) is one immersive approach being explored in this context. This study examines the feasibility and tolerability of integrating VR into maintenance ketamine/esketamine sessions. Study 1 surveyed patients receiving ketamine/esketamine regarding their dissociative experience and openness to integrating virtual reality into treatment. In study 2, patients receiving esketamine integrated VR into clinical treatment. Participants were trained in the use of a VR headset and completed one esketamine session with VR. The primary objective was to assess safety, tolerability, and feasibility. Participants from Study 1 highlighted auditory (33%, 7/21) and visual (52%, 11/21) discomfort as common challenges during ketamine treatment; the majority (71%, 15/21) expressed openness to integrating VR into clinical treatment. In Study 2, five patients integrated VR into a single treatment session, with one using it throughout the session. Participants who wore glasses had difficulty integrating VR and reported nausea. All participants showed decreased altered experience as measured by the 5-Dimensional Altered States of Consciousness scale. This pilot study examines factors affecting the feasibility and tolerability of VR during ketamine treatment and highlights considerations for future research. The observed reduction in 5D-ASC scores raises questions about whether VR dampens dissociative intensity, with potential clinical implications warranting further exploration.

In the evidence

This study is part of the evidence base for 2 syntheses in the library. Here is how each one recorded it.

• State of the evidence: Esketamine for depression ↕Mixed

  Patients commonly reported audiovisual discomfort during treatment and most were open to VR; in five patients using VR during an esketamine session, glasses wearers had difficulty and nausea, and altered-state scores were reduced.

  Synthesized October 22, 2026

• State of the evidence: Esketamine ↕Mixed

  Patients commonly reported auditory and visual discomfort during ketamine treatment and most were open to virtual reality; in five patients who used VR during an esketamine session, glasses wearers had difficulty and reported nausea, and all showed reduced altered-state scores.

  Synthesized September 27, 2026

Comparable studies

Other case reports and case series on esketamine for depression, most cited first.