Listening to music during intranasal (es)ketamine treatment for therapy-resistant depression is linked to reduced anxiety and lower blood pressure, stable or increased dissociation, and tolerance for higher doses. In a review of 494 sessions from 37 patients, those who listened to music received higher average doses (131.5 mg vs. 116.7 mg), reported less anxiety (0.4 vs. 1.4 points), and had lower peak systolic blood pressure (137.9 vs. 140.3 mmHg) compared to those who did not. Music did not affect depression scores between sessions.
Adding a daily 30-day mindfulness mobile app (Headspace) to standard treatment helped reduce depression severity more than standard treatment alone in people with major depressive disorder. In a randomized trial with 83 patients, those using the app showed a significantly greater decrease in clinician-rated depression scores (HDRS) and lower systolic blood pressure after one month. Both groups improved from partial remission at hospital discharge, but the app group improved more. The total dropout rate was 29%. Short-term app-based mindfulness appears beneficial as a supplement to usual care.
Intranasal racemic ketamine is non-inferior to esketamine for reducing depression symptoms in adults with treatment-resistant depression, with comparable symptom improvement over four weeks. However, remission rates were higher with esketamine (38.7%) than with racemic ketamine (15.6%), and racemic ketamine failed to meet non-inferiority for remission. Safety profiles were similar, though racemic ketamine caused slightly more transient blood pressure elevations. Racemic ketamine may be a cost-effective alternative where esketamine access is limited, but higher remission with esketamine warrants further study.