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

Autor: Lapidos A; Department of Psychiatry, University of Michigan Medical School, USA. Electronic address: alapidos@umich.edu., Lopez-Vives D; Department of Psychiatry, University of Michigan Medical School, USA., Sera CE; Department of Psychiatry, University of Michigan Medical School, USA., Ahearn E; Department of Psychiatry, University of Michigan Medical School, USA., Vest E; Department of Psychiatry, University of Michigan Medical School, USA., Senic I; Department of Psychiatry, University of Michigan Medical School, USA., Vande Voort JL; Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, USA., Frye M; Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, USA., Goes FS; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, USA., Achtyes E; Pine Rest Christian Mental Health Services, USA; Division of Psychiatry & Behavioral Medicine, Michigan State University College of Human Medicine, USA., Greden J; Department of Psychiatry, University of Michigan Medical School, USA; Eisenberg Family Depression Center., Parikh SV; Department of Psychiatry, University of Michigan Medical School, USA; Eisenberg Family Depression Center.
Jazyk: angličtina
Zdroj: Journal of affective disorders [J Affect Disord] 2023 Feb 15; Vol. 323, pp. 534-539. Date of Electronic Publication: 2022 Dec 05.
DOI: 10.1016/j.jad.2022.11.090
Abstrakt: 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.
Competing Interests: Declaration of competing interest Adrienne Lapidos, Daniela Lopez-Vives, Cortney E. Sera, Elizabeth Ahearn, Erica Vest, Ivana Senic, and John Greden have no conflicts of interest to declare. Dr. Vande Voort has received grant-in-kind support for supplies and genotyping from Assurex Health. Dr. Frye has received grant support from Assurex Health, and Mayo Foundation. He also has financial interests in Chymia LLC. Dr. Goes has received research grant support from Janssen Therapeutics. Dr. Achtyes has served on advisory boards or consulted for Alkermes, Atheneum, Janssen, Karuna, Lundbeck/Otsuka, Roche, Sunovion and Teva and reports previous stock holdings in AstraZeneca, Johnson & Johnson, Moderna, and Pfizer. Dr. Achtyes has received research support from Alkermes, Astellas, Biogen, Boehringer-Ingelheim, InnateVR, Janssen, National Network of Depression Centers, Neurocrine Biosciences, Novartis, Otsuka, Pear Therapeutics, and Takeda. Dr. Achtyes serves as an advisor to CAPNOS Zero, the World Psychiatric Association and Clubhouse International, and the SMI Adviser LAI Center of Excellence (all unpaid). Dr. Parikh has received honoraria for consulting or research funds from Assurex (Myriad), Sage, Otsuka, Takeda, Janssen, Aifred, Mensante, Canadian Institutes for Health Research, Ontario Brain Institute, and the Flinn Foundation.
(Copyright © 2022 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: