Context matters. Why clinical psychedelic research needs patient perspectives.

Abstract

Ketamine is increasingly used to treat patients with depression, and an intranasal esketamine spray was recently registered as an approved treatment of treatment-refractory depression (TRD). Phase 3 randomized controlled trials with psilocybin have started in North America and will soon start in Europe. Depending on the outcome of these trials, psilocybin may also receive marketing authorization in the coming years for treatment of TRD and other mood disorders may soon follow. 

While the influence of ‘set and setting’ on the effects of psychedelics is broadly acknowledged, this common knowledge is not always reflected in the way these treatments are offered. In this talk, I will present data on two qualitative studies on patients who were treated with either oral s-ketamine or psilocybin for treatment-resistant depression. This presentation will discuss the phenomenology of the acute drug experience, patients’ attempts to surrender to or maintain control over experiences that were frequently overwhelming, and their perspectives on the treatment as a whole. 

Patients’ experiences indicate an urgent need to optimize the treatment process and to tailor therapeutic approaches. There are relatively straightforward improvements that can be implemented to improve the quality of patient care in future psychedelic treatments. Only by listening to, and rigorously studying, patient experiences can the real-life potential of psychedelics in the treatment of patients with depression be truly established.

Biography

Joost Breeksema holds an MA in philosophy and is a PhD candidate at the Department of Psychiatry at the University Medical Center Groningen, The Netherlands, where he conducts various qualitative studies. He believes that a closer examination of the perspectives of patients and therapists involved in treatments with different psychedelics for severe mental disorders can deepen our understanding of the therapeutic mechanisms involved and how the multiple variables comprising set, setting, therapeutic framework, and other contextual factors influence these treatments.

He is also executive director of the OPEN Foundation. This Amsterdam-based non-profit has been advocating for interdisciplinary research into, and potential therapeutic applications of psychedelic since 2007. OPEN organizes the biannual Interdisciplinary Conference on Psychedelic Research (ICPR), Europe’s longest-running conference on psychedelics, focusing on high-quality scientific research, therapeutic innovations, and critical discussions around ethics, policy, and more. ICPR 2024 takes place in Haarlem, from 6 to 8 June, 2024. Underlying all his work is a deep-seated belief in the scientifically grounded, responsible and ethical integration of psychedelics that respects the multiplicity of other, non-medical approaches.