TY - JOUR
T1 - Holding on or letting go? Patient experiences of control, context, and care in oral esketamine treatment for treatment-resistant depression
T2 - A qualitative study
AU - Breeksema, Joost J.
AU - Niemeijer, Alistair
AU - Kuin, Bouwe
AU - Veraart, Jolien
AU - Kamphuis, Jeanine
AU - Schimmel, Nina
AU - van den Brink, Wim
AU - Vermetten, Eric
AU - Schoevers, Robert
N1 - Funding Information: Author RS received a research grant from the Netherlands Organization Health Research and Development for a clinical study on oral esketamine and is the co-investigator of a clinical study on psilocybin funded by Compass Pathways. He has also received an educational grant from Janssen, Pharmaceutical Companies of Johnson and Johnson, and an honorarium from Clexio Biosciences. Author EV was the principal investigator of a clinical trial on MDMA funded by the Multidisciplinary Association for Psychedelic Studies. Author WB has been a consultant for Janssen Netherlands and is a member of the Scientific Advisory Board of Clearmind. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Publisher Copyright: Copyright © 2022 Breeksema, Niemeijer, Kuin, Veraart, Kamphuis, Schimmel, van den Brink, Vermetten and Schoevers.
PY - 2022/11/25
Y1 - 2022/11/25
N2 - 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.
AB - 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.
KW - esketamine
KW - ketamine
KW - patient experience
KW - phenomenology
KW - quality of care (QoC)
KW - set and setting
KW - treatment-resistant depression (TRD)
UR - http://www.scopus.com/inward/record.url?scp=85143757114&partnerID=8YFLogxK
U2 - https://doi.org/10.3389/fpsyt.2022.948115
DO - https://doi.org/10.3389/fpsyt.2022.948115
M3 - Article
C2 - 36506427
SN - 1664-0640
VL - 13
JO - Frontiers in psychiatry
JF - Frontiers in psychiatry
M1 - 948115
ER -