Ketamine treatment for individuals with treatment-resistant depression: a longitudinal qualitative interview study of patient experiences

Lascelles, Karen, Marzano, Lisa ORCID: https://orcid.org/0000-0001-9735-3512, Brand, Fiona, Trueman, Hayley, McShane, Rupert and Hawton, Keith (2021) Ketamine treatment for individuals with treatment-resistant depression: a longitudinal qualitative interview study of patient experiences. BJPsych Open, 7 (1) , e9. pp. 1-8. ISSN 2056-4724 [Article] (doi:10.1192/bjo.2020.132)

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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 six 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 two or more months later. Data were analysed thematically.

Results
Most participants hoped that ketamine would provide respite from their depression. All experienced improvement in mood following initial treatments, ranging from negligible to dramatic, and eight 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. The transient nature and cost of treatment were problematic. Eleven participants experienced side-effects, which in two cases were significant. 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 of associated increased hopelessness and suicidality.

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