This qualitative study (n=12) conducted within a Phase II double-blind randomized controlled trial, examines participant experiences of ketamine infusions (56mg/70kg) and how these relate to therapeutic mechanisms in a clinical trial setting. Subjective feelings of dissociation and detachment from one’s sense of self and physical body were accompanied by seemingly paradoxical feelings of connectedness with the universe and of decreased self-importance and self-absorption, which led to a transformation of the patients’ self-reported relationship to alcohol.

Abstract

“Background: The therapeutic benefits of ketamine have been demonstrated for a variety of psychiatric disorders. However, the role of ketamine induced psychoactive experiences in mediating the therapeutic effects is unclear. Despite the growing quantitative research on the efficacy of ketamine treatment, very few studies examined participant experiences of ketamine infusions in a treatment setting.

Aims: The current study aimed to examine participant experiences of ketamine infusions and how these relate to therapeutic mechanisms in a clinical trial setting.

Methods: We conducted semi-structured interviews with 12 participants who received up to three ketamine infusions (0.8 mg/kg) as part of a Phase II double blind, randomised controlled trial. The interviews explored participants’ acute experiences of ketamine infusions, experiences of psychotherapy/education, and the lasting effects of the trial. The interviews were transcribed verbatim and analysed using thematic analysis.

Results: Six key themes were identified. (1) Participants reported multifaceted motivations for trial participation. (2) The set and setting was found to be influential in determining acute ketamine experiences. The acute ketamine experiences included: (3) the inherent contradictions of the experience (e.g., dissociation vs feelings of connection), (4) rapidly fluctuating and changing experiences, (5) meaningful, mystical and spiritual experiences. Finally, the final theme (6) relates to the transformational effects of the infusions and the trial.

Conclusion: Provided in a supportive and professional environment, ketamine treatment led to a significant change in relationship with alcohol. Ketamine induced ego dissolution and dissociation were reported to be related to the transformational effects on relationship with alcohol. The extent to which the acute psychoactive effects of ketamine mediate therapeutic effects on drinking outcomes remain to be investigated in the trial data. The acute effects of ketamine reported by our participants transcend its traditional conceptualisation as a “dissociative anaesthetic”; therefore, we suggest the development or use of new measures alongside ketamine infusions to fully capture the spectrum of these effects which may be crucial in its therapeutic and transformative effects.”

Authors: O. Merve Mollaahmetoglu, Johanna Keeler, Katherine J. Ashbullby, Eirini Ketzitzidou-Argyri, Meryem Grabski & Celia JA Morgan

Summary of “This Is Something That Changed My Life”: A Qualitative Study of Patients’ Experiences in a Clinical Trial of Ketamine Treatment for Alcohol Use Disorders

Introduction

Ketamine is an N-methyl-d-aspartate (NMDA) receptor antagonist that produces powerful dissociative effects. It has been shown to display rapid antidepressant effects and has been used in the treatment of several psychiatric disorders, including unipolar/bipolar depression, post-traumatic stress disorder, generalised anxiety disorders, obsessive compulsive disorder, and substance use disorders.

Ketamine acutely can induce mystical and psychedelic effects, which have been thought of as adverse effects in the psychiatric literature. However, there is evidence to suggest that these effects may be important therapeutically, and that ketamine-induced psychedelic experiences may be beneficial for treatment of alcohol and heroin use disorders.

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