In recent years, the therapeutic use of (es)ketamine, a derivative of the anesthetic ketamine, has gained attention for its rapid antidepressant effects, particularly in treatment-resistant depression. However, its administration is not without side effects, including dissociative symptoms, anxiety, and elevated blood pressure. A new exploratory study has provided fresh insights into how listening to music during intranasal (es)ketamine administration can influence these side effects, offering a potential path to optimizing patient comfort and treatment tolerability.
The study, which compared sessions of (es)ketamine administration with and without music, revealed no significant impact of music on the overall efficacy of the treatment, as measured by changes in the Montgomery-Åsberg Depression Rating Scale (MADRS) and Beck Depression Inventory (BDI) scores. This indicates that while music does not enhance the antidepressant effect of (es)ketamine, it also does not detract from its effectiveness. The focus of the study was instead on how music might alter the experience and side effects associated with the therapy.
One of the key findings was that music increased the degree of dissociation, specifically depersonalization, a feeling of being detached from one’s body or self. This effect was measured by the Dissociative Symptom Scale (DSS), where patients who listened to music reported a mean increase of 0.6 points in depersonalization. This suggests that music may enhance certain dissociative experiences during (es)ketamine administration, though it did not significantly affect other dissociative symptoms like visual dissociation, derealization, or analgesia.
Interestingly, despite the increased dissociation, patients who listened to music reported lower levels of anxiety and found the sessions more pleasant compared to those who did not listen to music. The reduction in anxiety, measured by a mean decrease of 1 point, and the increase in perceived pleasantness, with a mean difference of 0.6 points, suggest that music may help patients better tolerate the dissociative effects of (es)ketamine. This aligns with previous research indicating that music can improve the tolerance of dissociative symptoms, reducing distress, confusion, and agitation.
Another significant finding was the impact of music on blood pressure. Patients who listened to music during their (es)ketamine sessions exhibited a significantly lower maximum systolic blood pressure compared to those who did not listen to music. Given that (es)ketamine can cause elevations in blood pressure, this suggests that music could be a simple and cost-effective intervention to mitigate this side effect.
Additionally, the study found that patients in the music group were able to tolerate higher doses of (es)ketamine, with a mean increase of 14.8 mg. This supports the hypothesis that music enhances subjective tolerability, allowing for higher doses to be administered without increasing discomfort or adverse effects.
While the study provides valuable insights, the authors note several limitations, including the self-selected nature of the music and the lack of randomized control, which could influence the outcomes. Future research is needed to explore these effects in more detail, including the impact of specific music genres and randomized trials.
In summary, this study underscores the potential of music as a supportive intervention in (es)ketamine therapy. By improving the tolerability of side effects, reducing anxiety, and helping to manage blood pressure, music offers a holistic approach that could enhance patient-centered care in the treatment of depression.
