氯胺酮治疗难治性抑郁症患者：患者体验的纵向定性访谈研究
Ketamine treatment for individuals with treatment-resistant depression: longitudinal qualitative interview study of patient experiences.
作者信息
Lascelles Karen, Marzano Lisa, Brand Fiona, Trueman Hayley, McShane Rupert, Hawton Keith
机构信息
Oxford Health NHS Foundation Trust; and Centre for Suicide Research, Department of Psychiatry, University of Oxford, UK.
Faculty of Science and Technology, Middlesex University, UK.
出版信息
BJPsych Open. 2020 Dec 7;7(1):e9. doi: 10.1192/bjo.2020.132.
BACKGROUND
Ketamine has recently received considerable attention regarding its antidepressant and anti-suicidal effects. Trials have generally focused on short-term effects of single intravenous infusions. Research on patient experiences is lacking.
AIMS
To investigate the experiences over time of individuals receiving ketamine treatment in a routine clinic, including impacts on mood and suicidality.
METHOD
Twelve fee-paying patients with treatment-resistant depression (6 females, 6 males, age 21-70 years; 11 reporting suicidality and 6 reporting self-harm) who were assessed as eligible for ketamine treatment participated in up to three semi-structured interviews: before treatment started, a few weeks into treatment and ≥2 months later. Data were analysed thematically.
RESULTS
Most participants hoped that ketamine would provide respite from their depression. Nearly all experienced improvement in mood following initial treatments, ranging from negligible to dramatic, and eight reported a reduction in suicidality. Improvements were transitory for most participants, although two experienced sustained consistent benefit and two had sustained but limited improvement. Some participants described hopelessness when treatment stopped working, paralleled by increased suicidal ideation for three participants. The transient nature and cost of treatment were problematic. Eleven participants experienced side-effects, which were significant for two participants. Suggestions for improving treatment included closer monitoring and adjunctive psychological therapy.
CONCLUSIONS
Ketamine treatment was generally experienced as effective in improving mood and reducing suicidal ideation in the short term, but the lack of longer-term benefit was challenging for participants, as was treatment cost. Informed consent procedures should refer to the possibilities of relapse and associated increased hopelessness and suicidality.
背景
氯胺酮最近在其抗抑郁和抗自杀作用方面受到了广泛关注。试验通常集中在单次静脉输注的短期效果上。缺乏对患者体验的研究。
目的
调查在常规诊所接受氯胺酮治疗的个体随时间推移的体验，包括对情绪和自杀倾向的影响。
方法
12名付费的难治性抑郁症患者（6名女性，6名男性，年龄21 - 70岁；11名报告有自杀倾向，6名报告有自残行为）被评估为符合氯胺酮治疗条件，参与了多达三次半结构化访谈：治疗开始前、治疗几周后以及≥2个月后。对数据进行了主题分析。
结果
大多数参与者希望氯胺酮能缓解他们的抑郁症状。几乎所有参与者在初始治疗后情绪都有改善，改善程度从轻微到显著不等，8名参与者报告自杀倾向有所降低。对大多数参与者来说，改善是短暂的，尽管有两名参与者持续获得了稳定的益处，两名参与者有持续但有限的改善。一些参与者在治疗不再起作用时描述了绝望感，三名参与者同时出现了自杀意念增加的情况。治疗的短暂性和成本是个问题。11名参与者经历了副作用，其中两名参与者的副作用较为严重。改善治疗的建议包括更密切的监测和辅助心理治疗。
结论
氯胺酮治疗在短期内通常被认为对改善情绪和降低自杀意念有效，但缺乏长期益处对参与者来说是个挑战，治疗成本也是如此。知情同意程序应提及复发的可能性以及相关的绝望感和自杀倾向增加的情况。
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