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

Article

Lascelles, K., Marzano, L., Brand, F., Trueman, H., McShane, R. and Hawton, K. 2021. Ketamine treatment for individuals with treatment-resistant depression: a longitudinal qualitative interview study of patient experiences. BJPsych Open. 7 (1), pp. 1-8. https://doi.org/10.1192/bjo.2020.132
TypeArticle
TitleKetamine treatment for individuals with treatment-resistant depression: a longitudinal qualitative interview study of patient experiences
AuthorsLascelles, K., Marzano, L., Brand, F., Trueman, H., McShane, R. and Hawton, K.
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.

Keywordsketamine; treatment-resistant depression; mood; suicidal ideation; side-effects
Research GroupApplied Health Psychology group
PublisherCambridge University Press
JournalBJPsych Open
ISSN2056-4724
Publication dates
Online07 Dec 2020
Print01 Jan 2021
Publication process dates
Deposited23 Oct 2020
Accepted19 Oct 2020
Output statusPublished
Publisher's version
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Copyright Statement

Copyright and usage
© The Author(s), 2020. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Digital Object Identifier (DOI)https://doi.org/10.1192/bjo.2020.132
Web of Science identifierWOS:000596232000001
LanguageEnglish
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Psychiatric disorders in male prisoners who made near-lethal suicide attempts: case-control study
Rivlin, A., Hawton, K., Marzano, L. and Fazel, S. 2010. Psychiatric disorders in male prisoners who made near-lethal suicide attempts: case-control study. The British Journal of Psychiatry. 197 (4), pp. 313-319. https://doi.org/10.1192/bjp.bp.110.077883
Psychiatric disorders in women prisoners who have engaged in near-lethal self-harm: case–control study
Marzano, L., Fazel, S., Rivlin, A. and Hawton, K. 2010. Psychiatric disorders in women prisoners who have engaged in near-lethal self-harm: case–control study. The British Journal of Psychiatry. 197 (3), pp. 219-226. https://doi.org/10.1192/bjp.bp.109.075424
Visuospatial superiority in developmental dyslexia: myth or reality?
Brunswick, N., Martin, G. and Marzano, L. 2010. Visuospatial superiority in developmental dyslexia: myth or reality? Learning and Individual Differences. 20 (5), pp. 421-426. https://doi.org/10.1016/j.lindif.2010.04.007
Justice and care: theorising the 'new man' and the 'caring father.'
Marzano, L., Capdevila, R., Ciclitira, K. and Lazard, L. 2009. Justice and care: theorising the 'new man' and the 'caring father.'. Psychology of Women Secton Review. 11 (2), pp. 11-20.
Theoretical and ethical issues in conducting research at a women’s centre.
Ciclitira, K. and Marzano, L. 2004. Theoretical and ethical issues in conducting research at a women’s centre. Proceedings of the British Psychological Society. 12 (2).
Being a man: justice and care.
Capdevila, R., Ciclitira, K., Lazard, L. and Marzano, L. 2006. Being a man: justice and care. Psychology of Women Section Annual Conference 2005.. University of Huddersfield. The British Psychological Society.
Theoretical and ethical issues in conducting research at a women’s health centre.
Ciclitira, K., Marzano, L., Brunswick, N., Starr, F. and Berger, S. 2004. Theoretical and ethical issues in conducting research at a women’s health centre. Psychology of Women Section Review. 6 (1), pp. 60-69.
Non voluntary return? The politics of refugee return to Afghanistan
Sales, R., Blitz, B. and Marzano, L. 2005. Non voluntary return? The politics of refugee return to Afghanistan. Political Studies. 53 (1), pp. 182-200.