Letting Go of Control and Embracing the Journey
Article Title: “Holding on or Letting Go? Patient Experiences of Control, Context, and Care in Oral Esketamine Treatment for Treatment-Resistant Depression: A Qualitative Study”
Authors: Joost J. Breeksema, Alistair Niemeijer, Bouwe Kuin, Jolien Veraart, Jeanine Kamphuis, Nina Schimmel, Wim van den Brink, Eric Vermetten, Robert Schoevers
Publication Date: 2022
Background
Esketamine, a derivative of ketamine, is a novel treatment for treatment-resistant depression (TRD), offering rapid yet temporary relief from depressive symptoms. While its psychoactive effects are well-documented, there is limited understanding of how patients experience these effects and the conditions that best support their treatment journey. This study explores the lived experiences of patients undergoing oral esketamine treatment, aiming to identify factors that can optimise their care and outcomes.
Study Overview
This qualitative study used in-depth interviews with 17 TRD patients who participated in a six-week oral esketamine treatment program, followed by six months of at-home use. The study employed Interpretative Phenomenological Analysis (IPA) to explore patients’ perspectives on control, preparation, emotional support, and the setting during their treatment.
Key Findings
Overwhelming Experiences: Patients often encountered intense, sometimes frightening psychoactive effects, which were influenced by their preparation, mood, and the level of support they received.
Inadequate Preparation: Many patients felt unprepared for the psychoactive effects, often expecting none during initial low-dose sessions, leading to unexpected distress.
Control vs Letting Go: A central theme was the struggle between maintaining control and surrendering to the experience. Successful sessions were often those where patients managed to let go, enhancing the therapeutic effect.
Mood States and Support: The mood at the start of each session significantly impacted patients’ experiences. Emotional support from staff and loved ones, as well as a supportive setting, were crucial for positive outcomes.
Supportive Settings: A calm, private, and comfortable environment significantly helped patients feel safe and willing to embrace the esketamine experience. Conversely, noisy or clinical settings heightened anxiety and reduced the effectiveness of the treatment.
Discussion
The study highlights that preparation, education, and emotional support are vital components of effective esketamine treatment. By informing patients about potential experiences and providing calming techniques, healthcare providers can help them better navigate their sessions. Emphasising the importance of set and setting—key factors in psychedelic therapies—can improve the quality of care, making esketamine treatment more effective for those struggling with TRD.
Implications
Understanding patient experiences in esketamine treatment offers valuable insights into improving the therapeutic process. Proper preparation, emotional and physical support, and an optimised setting can enhance the effectiveness of esketamine, allowing patients to achieve better mental health outcomes. These insights can guide training for healthcare providers and inform best practices for psychedelic-assisted therapies.
Potential Application
The findings suggest that esketamine retreats, clinics, and other treatment settings should prioritise preparation and emotional support as key aspects of care. By focusing on creating a safe, supportive, and comfortable environment, healthcare providers can help patients more effectively engage with their treatment, potentially leading to better long-term outcomes.
Conclusions
This study underscores the importance of patient-centred approaches in esketamine treatment for TRD. Enhancing the treatment experience through improved preparation, support, and setting can help patients manage overwhelming experiences and derive greater benefit from their sessions.
Reference:
Breeksema, J. J., Niemeijer, A., Kuin, B., Veraart, J., Kamphuis, J., Schimmel, N., van den Brink, W., Vermetten, E., & Schoevers, R. (2022). Holding on or letting go? Patient experiences of control, context, and care in oral esketamine treatment for treatment-resistant depression: A qualitative study. Frontiers in Psychiatry, 13, 948115. https://doi.org/10.3389/fpsyt.2022.948115
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