Inside the journey: A qualitative study of intravenous ketamine therapy for treatment-resistant depression

• Treatment-resistant depression (TRD) affects many individuals and is challenging to treat. • Intravenous (IV) ketamine has shown quick antidepressant effects, but its long-term outcomes and patient experiences are not well studied. • This qualitative study in Saskatchewan interviewed 19 individuals living with TRD undergoing IV ketamine therapy. • Key findings include variable effects during treatment such as psychological relief and altered perceptions. • Participants reported significant improvements in mood, life outlook, and daily functioning. Treatment-resistant depression (TRD) affects over 30 % of patients with depression and is associated with high morbidity and mortality. Intravenous (IV) ketamine has shown rapid and robust antidepressant effects for TRD. However, limited data exist on long-term maintenance and patient experiences, especially in North America. This study aims to explore the lived experiences of individuals receiving IV ketamine for TRD in Saskatchewan, Canada. This qualitative study involved semi-structured interviews with 19 individuals receiving IV ketamine at the Linden Medical Centre. Participants were included if they were over 18 years of age and received IV ketamine for TRD. Data were analyzed using grounded theory methodology to identify emerging themes. Key themes included the acute effects of ketamine during treatment, which varied among patients but generally involved psychological relief and altered perceptions. Participants noted significant improvements in mood, outlook on life, and daily functioning. However, barriers such as treatment cost, accessibility, and stigma were prevalent. Psychosocial factors and the clinic environment also substantially influenced treatment outcomes. The findings highlight the profound impact of IV ketamine on patients with TRD, emphasizing the importance of a supportive clinic environment and addressing barriers to accessibility. Despite the financial burden and limited accessibility, ketamine treatments resulted in meaningful improvements, including reduced suicidality. This study underscores the need for further research on individual predictors of ketamine response, cost-effectiveness, and educational materials to set realistic patient expectations. Understanding patient experiences can help optimize ketamine therapy for TRD, ultimately enhancing treatment outcomes.