Burnout Symptom Outcomes During At-Home Ketamine-Assisted Therapy: A Real-World Retrospective Analysis of 395 Adults

Among 395 adults with elevated burnout who completed six sessions of at-home ketamine-assisted therapy, 76.1% of those initially classified with the most severe burnout profile no longer met that classification after treatment, and the proportion classified as engaged (non-burned-out) rose from 16.7% to 49.4%. Improvements were largest on exhaustion and cynicism subscales. Because depression, a frequent comorbidity, was the primary treatment indication, the specific effect of ketamine on burnout cannot be separated from concurrent mood changes in this uncontrolled study. Randomized controlled trials are needed to confirm these findings.

Study at a glance

Abstract

Abstract Background Occupational burnout, recognized in ICD-11 as an occupational phenomenon, is a syndrome of chronic workplace stress comprising emotional exhaustion, cynicism (the analogue of the depersonalization dimension on the MBI-Human Services Survey form), and reduced professional efficacy on the Maslach Burnout Inventory-General Survey (MBI-GS). Burnout is common among US working adults; in a probability-based national sample, 25.2% reported burnout symptoms in 2020 (28.1% in 2017), measured with items from the Maslach Burnout Inventory. Established interventions for burnout include mindfulness-based interventions, third-wave cognitive-behavioral therapy, organizational interventions, and behavioral interventions. Ketamine, a non-competitive N-methyl-D-aspartate receptor antagonist, has rapid antidepressant effects and preclinical evidence of pro-resilience effects on chronic-stress models. Objective This exploratory, hypothesis-generating analysis describes self-reported burnout symptom outcomes, as measured by the three MBI-GS subscales and the published five-profile Maslach typology, among adults with elevated baseline burnout who completed at-home ketamine-assisted therapy through Mindbloom, a telehealth ketamine therapy platform. Methods We conducted a retrospective analysis of 395 adults with elevated baseline MBI-GS burnout (a moderate-or-higher operational threshold defined as Exhaustion ≥ 4.8 and either Cynicism ≥ 3.8 or Professional Efficacy ≤ 4.3) who completed all four scheduled MBI-GS assessments (baseline, post-session 2, post-session 4, and post-session 6) during enrollment in Mindbloom's at-home ketamine-assisted therapy program. Depression was the primary indication for treatment in this cohort and was present as a frequent comorbidity; burnout symptoms were assessed as a co-occurring dimension at the same timepoints. Burnout was characterized using the three MBI-GS subscales separately and the published five-profile Maslach typology (Engaged, Overextended, Disengaged, Ineffective, Burnout). Following the MBI-GS scoring manual (Mind Garden, Maslach et al., 4th ed., 2018), no aggregate composite burnout score is reported. Results Among the completers classified with full Burnout (the most severe Maslach profile) at baseline, 76.1% (95% Wilson CI 65.0–84.5%) achieved operational-threshold remission of the full Burnout classification at post-session 6. Of 1,642 participants who initiated treatment with a baseline MBI-GS meeting the moderate-or-higher burnout threshold, 395 (24.1%) completed the full six-session protocol with all four MBI-GS assessments. The proportion of completers classified as Engaged (the non-burned-out profile) grew from 16.7% at baseline to 49.4% at post-session 6 (a 2.95-fold increase). Subscale-level study-defined response (≥ 1-point improvement) was achieved by 55.4% on Exhaustion (95% CI 50.5–60.3%), 48.9% on Cynicism (44.0–53.8%), and 26.3% on Professional Efficacy (22.2–30.9%). Paired within-subject Cohen's d_z values were 0.95 on Exhaustion, 0.73 on Cynicism, and 0.20 on Professional Efficacy. Considered jointly across the three subscales, 69.6% of completers improved by at least 1 point on at least one dimension. 59.5% of completers achieved operational-threshold remission below the moderate-or-higher cohort-eligibility threshold at post-session 6. Side effects of any type were reported by 3.5% to 4.3% of completers across timepoints. Conclusions In this completer cohort, 76.1% of patients classified with full Burnout at baseline no longer met that classification at post-treatment, the Engaged classification grew nearly threefold, and within-subject standardized change was largest on the Exhaustion and Cynicism subscales. Because depression and burnout co-occur frequently and share substantial symptom overlap on validated instruments, the burnout-specific contribution of ketamine cannot be isolated from concurrent mood changes in this uncontrolled design; randomized controlled trials are needed to confirm these findings.