A qualitative and quantitative account of patient’s experiences of ketamine and its antidepressant properties

Abstract

Background: Ketamine is central to one of the most rapidly growing areas of neuroscientific research into novel treatments for depression. Limited research has indicated that the psychedelic properties of ketamine may play a role in its antidepressant effects. Aim: The aim of the current study was to explore the psychedelic experiences and sustained impact of ketamine in major depressive disorder. Methods: In the current study, ketamine (0.44 mg/kg) was administered to 32 volunteers with major depressive disorder in a crossover design with the active-placebo remifentanil, in a magnetic resonance imaging (MRI) environment. The 11-dimension altered states of consciousness questionnaire and individual qualitative interviews were used to capture the acute psychedelic experience. The Montgomery-Asberg Depression Rating Scale and further interviewing explored lasting effects. The second qualitative interview took place ⩾3 weeks post-ketamine. Results: Greater antidepressant response (reduction in Montgomery-Asberg Depression Rating Scale at 24 h) correlated with the 11-dimension altered states of consciousness dimensions: spirituality, experience of unity, and insight. The first qualitative interview revealed that all participants experienced perceptual changes. Additional themes emerged including loss of control and emotional and mood changes. The final interview showed evidence of a psychedelic afterglow, and changes to perspective on life, people, and problems, as well as changes to how participants felt about their depression and treatments. Conclusions: The current study provides preliminary evidence for a role of the psychedelic experience and afterglow in ketamine’s antidepressant properties. Reflexive thematic analysis provided a wealth of information on participants’ experience of the study and demonstrated the psychedelic properties of ketamine are not fully captured by commonly used questionnaires.

Psychedelics for the treatment of depression, anxiety, and existential distress in patients with a terminal illness: a systematic review

“…These psychedelic effects are usually either not addressed (Grabski et al, 2020;Mathai et al, 2020) or regarded as unwanted 'psychotic' side adverse effects in clinical trials (Romeo et al, 2015). In contrast, it has also been suggested that ketamine-induced psychedelic peak experiences may contribute to its antidepressant effect (Sumner et al, 2021). Interestingly, studies that administered ketamine to anesthetized patients-thereby canceling out acute psychedelic effects-reported short-term effects on depression, indicating that the psychedelic experience is not necessary for its effect on depression.…”

The Journal of Psychopharmacology: La Plus ça change. . .

“…Rachael Sumner and colleagues conducted qualitative interviews looking at the psychedelic experiences and sustained impact of ketamine in patients with major depressive disorder (MDD). This study provided preliminary evidence for the role of the psychedelic experience and afterglow in ketamine's antidepressant properties (Sumner et al, 2021). Furthermore, there may be a rationale for psychotherapeutic guidance as part of ketamine therapy for MDD, as well as greater attention to the context in which ketamine is administered.…”

“This Is Something That Changed My Life”: A Qualitative Study of Patients' Experiences in a Clinical Trial of Ketamine Treatment for Alcohol Use Disorders

“…In a subsequent study where participants with heroin use disorders were randomised to receive either a "psychedelic" dose of ketamine [2.0 mg/kg Intramuscular (IM)] or a "sub-psychedelic" dose (0.2 mg/kg IM), the rate of abstinence over 2 years was higher in the former group than the latter (14) indicating a therapeutic benefit of ketamine-induced psychedelic experiences. Additionally, in a recent report antidepressant response was correlated with dimensions of altered states of consciousness such as feelings of unity, spirituality and insight (15). Moreover, ketamine's therapeutic effects on motivation to quit cocaine and cocaine use were mediated by ketamine's mystical type effects-but not dissociative effects (16,17).…”