Ketamine treatment for individuals with treatment-resistant depression: longitudinal qualitative interview study of patient experiences
In a longitudinal qualitative study of 12 patients with treatment-resistant depression, ketamine typically produced short-term improvements in mood and reductions in suicidal ideation, but benefits were transient for most and some experienced increased hopelessness and suicidality as effects wore off. Participants also reported side-effects and cost concerns, prompting recommendations for closer monitoring, adjunctive psychological therapy and explicit informed consent about relapse and potential worsening of suicidality.
Authors
- Lascelles, K.
- Marzano, L.
- Brand, F.
Published
Abstract
Background
Ketamine 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.
Aims
To investigate the experiences over time of individuals receiving ketamine treatment in a routine clinic, including impacts on mood and suicidality.
Method
Twelve 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.
Results
Most 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.
Conclusions
Ketamine 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.
Research Summary of 'Ketamine treatment for individuals with treatment-resistant depression: longitudinal qualitative interview study of patient experiences'
Introduction
Ketamine has attracted attention as a potential rapid-acting antidepressant, particularly for people with treatment-resistant depression (TRD). Earlier randomised and uncontrolled studies have shown that single intravenous infusions can reduce depressive symptoms and suicidal ideation, but effects are typically transient. Most published work has focused on single infusions; repeated or maintenance regimens are less well characterised, and there is little qualitative research exploring how patients experience ketamine treatment over time, including expectations, side-effects and the emotional impact when benefits fade. Lascelles and colleagues set out to explore longitudinal patient experiences of ketamine treatment delivered in a routine UK clinic. The study aimed to document patients' expectations before treatment, short- and longer-term effects on mood and suicidal thinking, side-effects, and overall perspectives on the value and limitations of ketamine therapy for TRD within a real-world, self-funded clinic context.
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Study Details
- Study Typeindividual
- Journal
- Compound
- Topics
- APA Citation
Lascelles, K., Marzano, L., Brand, F., Trueman, H., McShane, R., & Hawton, K. (2021). Ketamine treatment for individuals with treatment-resistant depression: longitudinal qualitative interview study of patient experiences. BJPsych Open, 7(1). https://doi.org/10.1192/bjo.2020.132
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Papers cited by this study that are also in Blossom
Grunebaum, M. F., Galfalvy, H. C., Choo, T. H. et al. · American Journal of Psychiatry (2018)
Ionescu, D. F., Bentley, K. H., Eikermann, M. et al. · Journal of Affective Disorders (2019)
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Murrough, J. W., Iosifescu, D. V., Chang, L. C. et al. · American Journal of Psychiatry (2013)
Murrough, J. W., Wan, L., Levitch, C. F. et al. · Journal of Clinical Psychiatry (2015)
Short, B., Fong, J., Galvez, V. et al. · Lancet Psychiatry (2017)
Schwartz, J., Murrough, J. W., Iosifescu, D. V. · Evidence-Based Mental Health (2016)
Cited By (2)
Papers in Blossom that reference this study
Breeksema, J. J., Niemeijer, A. R., Kuin, B. et al. · Frontiers in Psychiatry (2022)
Gerner, J., Bloomfield-Clagett, B., Zarate, C. A. · Journal of Affective Disorders (2022)
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