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Breeksema JJ, Niemeijer A, Kuin B, Veraart J, Vermetten E, Kamphuis J, van den Brink W, Schoevers R. Phenomenology and therapeutic potential of patient experiences during oral esketamine treatment for treatment-resistant depression: an interpretative phenomenological study. Psychopharmacology (Berl) 2023:10.1007/s00213-023-06388-6. [PMID: 37222753 DOI: 10.1007/s00213-023-06388-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/12/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Ketamine and its enantiomers are widely researched and increasingly used to treat mental disorders, especially treatment-resistant depression. The phenomenology of ketamine-induced experiences and their relation to its psychotherapeutic potential have not yet been systematically investigated. AIMS To describe the phenomenology of patient experiences during oral esketamine treatment for treatment-resistant depression (TRD) and to explore the potential therapeutic relevance of these experiences. METHODS In-depth interviews were conducted with 17 patients after a 6-week, twice-weekly 'off label' generic oral esketamine (0.5-3.0mg/kg) treatment program. Interviews explored participants' perspectives, expectations, and experiences with oral esketamine treatment. Audio interviews were transcribed and analyzed using an Interpretative Phenomenological Analysis (IPA) framework. RESULTS The effects of ketamine were highly variable, and psychological distress was common in most patients. Key themes included (a) perceptual effects (auditory, visual, proprioceptive), (b) detachment (from body, self, emotions, and the world), (c) stillness and openness, (d) mystical-type effects (transcendence, relativeness, spirituality), and (e) fear and anxiety. Key themes related to post-session reports included (a) feeling hungover and fatigued, and (b) lifting the blanket: neutralizing mood effects. CONCLUSION Patients reported several esketamine effects with psychotherapeutic potential, such as increased openness, detachment, an interruption of negativity, and mystical-type experiences. These experiences deserve to be explored further to enhance treatment outcomes in patients with TRD. Given the frequency and severity of the perceived distress, we identify a need for additional support in all stages of esketamine treatment.
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Affiliation(s)
- Joost J Breeksema
- Department of Psychiatry, Research School of Behavioural and Cognitive Neurosciences (BCN), University Medical Center Groningen, University of Groningen, Postbus 30.001, 9700, RB, Groningen, the Netherlands.
| | - Alistair Niemeijer
- Department of Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
| | - Bouwe Kuin
- Department of Psychiatry, Research School of Behavioural and Cognitive Neurosciences (BCN), University Medical Center Groningen, University of Groningen, Postbus 30.001, 9700, RB, Groningen, the Netherlands
| | - Jolien Veraart
- Department of Psychiatry, Research School of Behavioural and Cognitive Neurosciences (BCN), University Medical Center Groningen, University of Groningen, Postbus 30.001, 9700, RB, Groningen, the Netherlands
- PsyQ Haaglanden, Parnassia Psychiatric Institute, The Hague, the Netherlands
| | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeanine Kamphuis
- Department of Psychiatry, Research School of Behavioural and Cognitive Neurosciences (BCN), University Medical Center Groningen, University of Groningen, Postbus 30.001, 9700, RB, Groningen, the Netherlands
| | - Wim van den Brink
- Amsterdam UMC, location Department of Psychiatry, Academic Medical Center, Amsterdam, the Netherlands
- Program Compulsivity, Impulsivity & Attention, Amsterdam Neuroscience Research, Amsterdam, the Netherlands
| | - Robert Schoevers
- Department of Psychiatry, Research School of Behavioural and Cognitive Neurosciences (BCN), University Medical Center Groningen, University of Groningen, Postbus 30.001, 9700, RB, Groningen, the Netherlands
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Affiliation(s)
- David S Mathai
- The Johns Hopkins University School of Medicine, Baltimore, USA
| | - David B Yaden
- The Johns Hopkins University School of Medicine, Baltimore, USA
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