Holding on or letting go? Patient experiences of control, context, and care in oral esketamine treatment for treatment-resistant depression: A qualitative study

Abstract

BackgroundKetamine and its enantiomer esketamine represent promising new treatments for treatment-resistant depression (TRD). Esketamine induces acute, transient psychoactive effects. How patients perceive esketamine treatment, and which conditions facilitate optimal outcomes, remains poorly understood. Understanding patient perspectives on these phenomena is important to identify unmet needs, which can be used to improve (es)ketamine treatments.AimsTo explore the perspectives of TRD patients participating in “off label” oral esketamine treatment.Materials and methodsIn-depth interviews were conducted with 17 patients (11 women) after a six-week, twice-weekly esketamine treatment program, and subsequently after six months of at-home use. Interviews explored participants’ perspectives, expectations, and experiences with esketamine treatment. Audio interviews were transcribed verbatim and analysed following an Interpretative Phenomenological Analysis (IPA) framework.ResultsKey themes included overwhelming experiences; inadequate preparation; letting go of control; mood states influencing session experiences; presence and emotional support, and supportive settings. Patients’ attempts to let go and give into vs. attempts to maintain control over occasionally overwhelming experiences was a central theme. Multiple factors influenced patients’ ability to give into the experience and appeared to impact their mood and anxiety about future sessions, including level of preparation and education, physical and emotional support, and setting during the session.ConclusionBetter preparation beforehand, an optimized treatment setting, and emotional and psychological support during (es)ketamine sessions can help patients to “let go” and may lead to better quality of care and outcomes. Recommendations to improve quality of patient care in (es)ketamine treatment are provided, including suggestions for the training of nurses and other support staff.

Perspectivas atuais sobre o uso de psilocibina no manejo da depressão resistente: revisão sistemática

“…As alterações médias dos mínimos quadrados desde o início até a semana 3 na pontuação foram -12,0 para 25 mg, -7,9 para 10 mg e -5,4 para 1 mg; a diferença entre o grupo de 25 mg e o grupo de 1 mg foi de -6,6 (intervalo de confiança [IC] de 95%, -10,2 a -2,9; P <0,001) e entre o grupo de 10 mg e o grupo de 1 mg foi de -2,5 (IC 95%, -6,2 a 1,2; P = 0,18 A depressão resistente é uma condição desafiadora que afeta uma parcela significativa da população, caracterizada pela falta de resposta adequada aos tratamentos convencionais disponíveis. Pacientes com depressão resistente frequentemente enfrentam dificuldades em encontrar alívio sintomático e experimentam um impacto substancial em sua qualidade de vida e bem-estar emocional (CARHART-HARRIS et al, 2016;GOODWIN et al, 2022;BREEKSEMA et al, 2024).…”

“…A psilocibina é um agonista dos receptores de serotonina que ocorre naturalmente em algumas espécies de cogumelos. Seu mecanismo de ação está associado à ativação dos receptores 5-HT2A, resultando em efeitos psicodélicos e modificações na atividade cerebral que podem influenciar positivamente o humor, a cognição e a percepção (CARHART-HARRIS et al, 2016;GOODWIN et al, 2022;BREEKSEMA et al, 2024).…”

“…Ao explorar a psilocibina como potencial intervenção terapêutica para a depressão resistente, é fundamental compreender não apenas seus efeitos farmacológicos, mas também seu potencial impacto na sintomatologia depressiva e na qualidade de vida dos pacientes. A investigação cuidadosa desse composto psicodélico pode abrir novas perspectivas no campo da saúde mental e no tratamento de condições psiquiátricas complexas (CARHART-HARRIS et al, 2016;GOODWIN et al, 2022;BREEKSEMA et al, 2024).…”

Patient perspectives and experiences with psilocybin treatment for treatment-resistant depression: a qualitative study

“…All interviews were conducted by the first author, who was not involved in the trial nor had prior contact with participants. Interviews loosely followed an interview guide, based on a previous study in which we explored patients perspectives on oral esketamine treatment for TRD 36 . The interview guide included open-ended questions, e.g., ‘what were your expectations of this treatment?’, ‘how did you experience the preparation sessions?’, or ‘can you describe what happened during the psilocybin session?’, intended to gauge patients’ impressions of the treatment process, to understand how patients made sense of their experiences, and to explore factors that may have benefitted or negatively impacted the experience.…”

“…Emergent themes were discussed within the multidisciplinary research team. For a more detailed description of the analysis procedure and steps, please see 36 . The Standards for Reporting Qualitative Research (SRQR) and the 32-item COREQ (consolidated criteria for reporting qualitative research) checklist were used to ensure methodological rigor 77 , 78 .…”