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

Joost J Breeksema; Alistair Niemeijer; Bouwe Kuin; Jolien Veraart; Jeanine Kamphuis; Nina Schimmel; Wim van den Brink; Eric Vermetten; Robert Schoevers

doi:10.3389/fpsyt.2022.948115

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

Front Psychiatry. 2022 Nov 25:13:948115. doi: 10.3389/fpsyt.2022.948115. eCollection 2022.

Authors

Joost J Breeksema^{1

2

3}, Alistair Niemeijer⁴, Bouwe Kuin¹, Jolien Veraart^{1

5}, Jeanine Kamphuis¹, Nina Schimmel¹, Wim van den Brink^{6

7}, Eric Vermetten³, Robert Schoevers^{1

2}

Affiliations

¹ Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands.
² Research School of Behavioural and Cognitive Neurosciences (BCN), University Medical Center Groningen, Groningen, Netherlands.
³ Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands.
⁴ Department of Care Ethics, University of Humanistic Studies, Utrecht, Netherlands.
⁵ PsyQ Haaglanden, Parnassia Psychiatric Institute, The Hague, Netherlands.
⁶ Department of Psychiatry, Amsterdam UMC Locatie AMC, University of Amsterdam, Amsterdam, Netherlands.
⁷ Amsterdam Neuroscience, Research Program Compulsivity, Impulsivity & Attention, Amsterdam, Netherlands.

Abstract

Background: Ketamine 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.

Aims: To explore the perspectives of TRD patients participating in "off label" oral esketamine treatment.

Materials and methods: In-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.

Results: Key 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.

Conclusion: Better 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.

Keywords: esketamine; ketamine; patient experience; phenomenology; quality of care (QoC); set and setting; treatment-resistant depression (TRD).