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
Sustainable Development Goals3 Good health and well-being
Middlesex University ThemeHealth & Wellbeing
Research GroupApplied Health Psychology group
PublisherCambridge University Press (CUP)
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
License
File Access Level
Open
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
Scopus EID2-s2.0-85107570110
Web of Science identifierWOS:000596232000001
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Has metadatahttp://www.scopus.com/inward/record.url?eid=2-s2.0-85107570110&partnerID=MN8TOARS
LanguageEnglish
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Marzano, L., Fazel, S., Rivlin, A. and Hawton, K. 2011. Near-lethal self-harm in women prisoners: contributing factors and psychological processes. The Journal of Forensic Psychiatry & Psychology. 22 (6), pp. 863-884. https://doi.org/10.1080/14789949.2011.617465
Self-harm in a men's prison: staff's and prisoners' perspectives.
Marzano, L. 2007. Self-harm in a men's prison: staff's and prisoners' perspectives. PhD thesis Middlesex University
Visuo-spatial ability and dyslexia: is there a male global advantage?
Brunswick, N., Martin, G. and Marzano, L. 2008. Visuo-spatial ability and dyslexia: is there a male global advantage? British Dyslexia Association International Conference, 2008 [Dyslexia: making links]. Harrogate, York 27 - 29 Mar 2008
Visuo-spatial ability, handedness and developmental dyslexia: just how sinister was Andy Warhol?
Brunswick, N., Martin, G. and Marzano, L. 2007. Visuo-spatial ability, handedness and developmental dyslexia: just how sinister was Andy Warhol? 25th European Workshop on Cognitive Neuropsychology. Bressanone, Italy 21 - 26 Jan 2007
To be or not to be … a psychologist: critical and feminist dilemmas.
Ciclitira, K., Capdevila, R., Marzano, L. and Adams, E. 2008. To be or not to be … a psychologist: critical and feminist dilemmas. 2008 BPS Annual Conference.. Dublin 04 Feb 2008
Counsellors’ experiences of working as volunteers at a women’s service.
Costa, A., Ciclitira, K. and Marzano, L. 2008. Counsellors’ experiences of working as volunteers at a women’s service. 2008 Psychology of Women Section 21st Anniversary Conference on 'Rights and Changes'.. Cumberland Lodge, The Great Park, Windsor.
The impact of personal psychotherapy and supervision on volunteer counsellors.
Ciclitira, K., Marzano, L., Starr, F., Brunswick, N., Costa, A. and Berger, S. 2009. The impact of personal psychotherapy and supervision on volunteer counsellors. 2009 BPS Annual Conference. Brighton, UK 01 - 03 Apr 2009
Afghan nationals in the UK: professional capacity and views on return
Sales, R., Blitz, B. and Marzano, L. 2002. Afghan nationals in the UK: professional capacity and views on return. Research commissioned by Refugee Action and the International Organization for Migration, London..
Self-harm in prisons: dominant models and (mis)understandings
Marzano, L. 2010. Self-harm in prisons: dominant models and (mis)understandings. in: Adler, J. and Gray, J. (ed.) Forensic psychology: concepts, debates and practice Willan. pp. 486-507
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
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.
Interviewing survivors of near-lethal self-harm: a novel approach for investigating suicide amongst prisoners
Marzano, L., Rivlin, A., Fazel, S. and Hawton, K. 2009. Interviewing survivors of near-lethal self-harm: a novel approach for investigating suicide amongst prisoners. Journal of Forensic and Legal Medicine. 16 (3), pp. 152-155. https://doi.org/10.1016/j.jflm.2008.08.011
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.
Being young feminists: discussions and (dis)contents
Adams, E., Del Busso, L., Foster, N., Majumdar, A., Marzano, L. and Papadima, M. 2007. Being young feminists: discussions and (dis)contents. Feminism and Psychology. 17 (3), pp. 291-294. https://doi.org/10.1177/0959353507079081
I. Is my work 'feminist' enough? Tensions and dilemmas in researching male prisoners who self-harm
Marzano, L. 2007. I. Is my work 'feminist' enough? Tensions and dilemmas in researching male prisoners who self-harm. Feminism and Psychology. 17 (3), pp. 295-301. https://doi.org/10.1177/0959353507079082
Supporting staff working with prisoners who self-harm: a survey of support services for staff dealing with self-harm in prisons in England and Wales
Marzano, L. and Adler, J. 2007. Supporting staff working with prisoners who self-harm: a survey of support services for staff dealing with self-harm in prisons in England and Wales. International Journal of Prisoner Health. 3 (4), pp. 268-282. https://doi.org/10.1080/17449200701682501
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. https://doi.org/10.1111/j.1467-9248.2005.00523.x
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.