Patients' recovery and non-recovery narratives after intravenous ketamine for treatment-resistant depression

Adrienne Lapidos; Daniela Lopez-Vives; Cortney E Sera; Elizabeth Ahearn; Erica Vest; Ivana Senic; Jennifer L Vande Voort; Mark Frye; Fernando S Goes; Eric Achtyes; John Greden; Sagar V Parikh

doi:10.1016/j.jad.2022.11.090

Patients' recovery and non-recovery narratives after intravenous ketamine for treatment-resistant depression

J Affect Disord. 2023 Feb 15:323:534-539. doi: 10.1016/j.jad.2022.11.090. Epub 2022 Dec 5.

Authors

Affiliations

¹ Department of Psychiatry, University of Michigan Medical School, USA. Electronic address: alapidos@umich.edu.
² Department of Psychiatry, University of Michigan Medical School, USA.
³ Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, USA.
⁴ Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, USA.
⁵ Pine Rest Christian Mental Health Services, USA; Division of Psychiatry & Behavioral Medicine, Michigan State University College of Human Medicine, USA.
⁶ Department of Psychiatry, University of Michigan Medical School, USA; Eisenberg Family Depression Center.

PMID: 36481228
DOI: 10.1016/j.jad.2022.11.090

Abstract

Background: Intravenous (IV) ketamine is an effective therapy for treatment-resistant depression. A large data base is confirmatory and steadily expanding. Qualitative studies can inform best practices and suggest new research directions. As part of a clinical trial designed to identify biomarkers of ketamine response, a qualitative study was conducted to characterize experiences with: receiving infusions; recovering or not recovering from depression; and beliefs about why ketamine worked or did not work.

Methods: Adults with treatment-resistant depression received three IV ketamine infusions in a two-week period and were characterized as remitters or non-remitters via symptom reduction 24 h after the third infusion. Qualitative interviews of a subset of participants were audio recorded, transcribed verbatim, and coded using deductive and inductive methods. Themes were derived and compared across a broader construct of recovery status.

Results: Of the 21 participants, nine (43 %) were characterized as having experienced remission and 12 (57 %) non-remission. Of the 12 non-remitters, five were characterized as having experienced partial recovery based on their subjective experiences, reporting substantial benefit from ketamine infusions despite non-remission status based on scale measurements. Attributions for ketamine's effects included biological and experiential mechanisms. Among non-remitters there was risk of disappointment when adding another failed treatment.

Limitations: A more diverse sample may have yielded different themes. Different patients had different amounts of time elapsed between ketamine infusions and qualitative interview.

Conclusions: Qualitative methods may enhance researchers' characterization of IV ketamine's impact on treatment-resistant depression. While requiring confirmation, patients may benefit from a preparatory milieu that prepares them for multiple recovery pathways; decouples the psychedelic experience from clinical outcomes; and addresses potential risks of another failed treatment.

Keywords: Intravenous ketamine; Qualitative methods; Recovery; Remission; Treatment-resistant depression.

Publication types

Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Antidepressive Agents / therapeutic use
Depression / drug therapy
Depressive Disorder, Treatment-Resistant* / drug therapy
Hallucinogens* / therapeutic use
Humans
Infusions, Intravenous
Ketamine* / therapeutic use
Treatment Outcome

Substances

Antidepressive Agents
Hallucinogens
Ketamine