Pilot Implementation Of Mindfulness Meditation With Esketamine For Major Depressive Disorder
Background:
Esketamine is a novel antidepressant that has shown greater efficacy than traditional medications, and its efficacy may be enhanced with adjunctive psychotherapeutic strategies. Mindfulness meditation shows promise in reducing depressive symptoms, yet its integration into esketamine therapy remains underexplored. Mindfulness meditation is hypothesized to enhance esketamine’s pharmacological action based on the neuroplasticity theory of depression.
Purpose:
Evaluate whether integrating mindfulness meditation into esketamine treatment improves depressive symptoms, mindful awareness, and patients’ sense of agency, compared to esketamine treatment alone.
Methodology:
A quasi-experimental quality improvement pilot was conducted in an outpatient psychiatric clinic with 19 patients receiving esketamine. 10 self-selected into the mindfulness group, engaging in guided mindfulness meditation during each of four esketamine induction sessions over 2 weeks. Depression severity (PHQ-8), self-compassion (FFMQ-SF SC subscale), acting mindfully (FFMQ-SF AM subscale), and sense of agency (HAO) were assessed pre/post-intervention.
Evaluation:
The mindfulness group had a 4.7-point reduction in PHQ-8 scores (SD=3.06) versus a 1-point in the usual care group (SD=2.78, p=0.01). Mindfulness participation was associated with a 3.7-point greater PHQ-8 reduction (SE=1.3, R²=0.31, p=0.01, Cohen’s d=1.27) relative to usual care. Participants in the mindfulness group had a 3.34-point increase in self-compassion (p< 0.01) and a 3-point increase in mindful awareness (p=0.06) from pretest to posttest. Increased self-compassion correlated with improved depression scores (Pearson R=-0.71, p=0.03)
Conclusion:
Mindfulness meditation is a feasible and beneficial adjunct to esketamine treatment for MDD. Future steps include scaling the intervention to a larger sample, exploring long-term effects, and optimizing the timing and duration of meditations.
