Coaching as an Adjunct to Ketamine Therapy for Treatment-Resistant Depression

NCT07563868 | Recruiting

• 2 other identifiers: 2025P002110GR1001602
• Study Type: interventional
• Target: 20
• Locations: 1 country
• Sites: 2

Brief Summary

This study is being conducted at Massachusetts General Hospital (MGH) to explore whether adding psychedelic coaching can enhance the effects of ketamine or esketamine maintenance treatment in individuals with treatment-resistant depression (TRD). The investigators are currently enrolling participants who are receiving ongoing maintenance intravenous (IV) ketamine or intranasal esketamine (Spravato) treatment at the MGH Ketamine Clinic. Participation in the study will involve adding coaching sessions to your existing ketamine maintenance treatment.

Conditions

Treatment Resistant Depression (TRD)

Keywords

Psychedelic Coaching; Ketamine Coaching; Depression

Outcome Measures

Primary Outcomes (2)

• To assess the feasibility of adjunctive coaching during ketamine/esketamine maintenance treatment.

  We will assess the feasibility of coaching, as indexed by at least 80% of participants (16 of 20 participants) completing 10 out of 12 coaching sessions. The investigators will also review all assessment procedures and calculate the percentage of completed assessments at each time point. In addition, the investigators will compute the number of participants for whom an AE occurred, along with their rate of occurrence, severity, and relationship to the study procedures.

  From enrollment to the end of treatment at Month 3

• To assess the acceptability of adjunctive coaching during ketamine/esketamine maintenance treatment.

  Acceptability will be assessed by calculating the mean and standard deviation of participant-reported net-promoter scores, which will range from 0 (would not recommend) to 10 (would definitely recommend). Additional acceptability metrics will include qualitative and quantitative responses to the post-coaching survey and the end-of-coaching survey.

  From enrollment to the end of treatment at Month 3

Secondary Outcomes (9)

• To explore whether coaching is associated with a reduction in the frequency of ketamine/esketamine maintenance treatments (measured in days) over the 3-month study period and 1-month follow-up.

  Baseline (3 ketamine treatments prior to enrollment), through the intervention (3 months after enrollment), and follow-up (1 month post-intervention)

• To explore whether coaching is associated with a change in dose (measured in mg) and/or need for anxiolytic medications prior to ketamine/esketamine treatment.

  Baseline (3 ketamine treatments prior to enrollment), through the intervention (3 months after enrollment), and follow-up (1 month post-intervention)

• To explore whether adjunctive coaching is associated with a change in depressive symptoms, as measured by the Montgomery-Åsberg Depression Rating Scale (MADRS) total score.

  Screening, Baseline, Month 1, Month 2, Month 3, and 1-Month Post Study Completion

• To explore whether coaching is associated with improvements in International Trauma Questionaire (ITQ) scores.

  Screening, Baseline, Month 1, Month 2, Month 3, and 1-Month Post Study Completion

• To explore whether coaching is associated with improvements in 5-item World Health Organization Well-Being Index (WHO-5) scores.

  Screening, Baseline, Month 1, Month 2, Month 3, and 1-Month Post Study Completion

Study Arms (1)

Psychedelic Coaching

EXPERIMENTAL

Behavioral: Psychedelic Integration Coaching

Interventions

Psychedelic Integration Coaching BEHAVIORAL

Participation in the study will involve adding coaching sessions to existing ketamine maintenance treatment for patients receiving ongoing maintenance IV ketamine or IN esketamine treatment at MGH's Ketamine Clinic. If participants are eligible, they will be invited to participate in 12 weekly, 50-minute one-on-one coaching sessions conducted via Zoom. These sessions are designed to help participants process and integrate their experiences with ketamine treatment, to support personal growth and symptom improvement. The coaching is non-clinical, collaborative, and participant-directed, and is provided by trained psychedelic integration coaches from the Fireside Project. Throughout the 3-month coaching period and again at a 1-month follow-up, participants will complete monthly study visits that include brief remote assessments with a study clinician, along with additional self-report questionnaires. These visits will take approximately 1 to 2 hours, depending on the time point.

Also known as: Coaching, Psychedelic Coaching

Psychedelic Coaching

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age 18 years or older at the time of informed consent/study enrollment.
• Ability to understand and provide informed consent.
• Fluent in English (spoken and written).
• Willingness to have coaching sessions recorded via HIPAA-compliant MGB approved video-based platform.
• Has a QIDS-SR score ≥ 11, indicating at least moderate depressive symptom severity at screening visit.
• Lifetime diagnosis of a depressive disorder according to the MINI.
• In the maintenance phase of ketamine or esketamine treatment, defined as the period following the initial acute treatment series (typically 2 treatments per week for 3 weeks).
• Patients must have completed at least 3 maintenance treatments prior to screening visit with a QIDS-SR score ≥ 11 noted from EPIC medical records from the 3 most recent maintenance treatments.
• Currently receiving maintenance IV ketamine or intranasal esketamine at the MGH Ketamine Clinic, with at least one treatment administered within the past 8 weeks, and planning to continue to be an active patient at the MGH Ketamine Clinic for the duration of the study.
• Has established care with a mental health provider (e.g., psychiatrist, therapist, or other licensed mental health clinician), and, if outside the MGB-healthcare system, agrees to sign a Release of Information form (ROI) with the study team.

You may not qualify if:

• Presence of an unstable medical condition, as determined by the study clinician.
• Significant neurocognitive impairment that impairs with individual's ability to maintain ADLs and would interfere with study participation, per study clinician judgment.
• Newly initiated psychotherapy within the past 3 months.
• Any condition or circumstance that, in the judgment of the Principal Investigator, makes participation unsafe or unsuitable.
• Any psychiatric condition that is currently primary, clinically predominant to their depression, or insufficiently stable such that it would interfere with study participation, per clinician judgment.
• Plan to switch from IV ketamine treatment to intranasal esketamine or plan to switch from intranasal esketamine to IV ketamine treatment at any point during study.
• Suicidality determined by the judgment of the study clinicians at screen, with a plan to act in next 6 months.
• A ≥25% reduction in QIDS total score from screen to baseline visit.

Sponsors & Collaborators

• Massachusetts General Hospital: lead
• Fireside Project: collaborator

Study Sites (2)

Massachusetts General Hospital's Depression and Clinical Research program

Boston, Massachusetts, 02114, United States

RECRUITING

Massachusetts General Hospital

Boston, Massachusetts, 02114, United States

RECRUITING

MeSH Terms

Conditions

Depressive Disorder, Treatment-Resistant; Depression

Condition Hierarchy (Ancestors)

Depressive Disorder; Mood Disorders; Mental Disorders; Behavioral Symptoms; Behavior

Study Officials

• Maren Nyer, PhD

  Massachusetts General Hospital and Harvard Medical School

  PRINCIPAL INVESTIGATOR

• Franklin King, MD

  Massachusetts General Hospital and Harvard Medical School

  PRINCIPAL INVESTIGATOR

• David Mischoulon, MD/PhD

  Massachusetts General Hospital and Harvard Medical School

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Maren Nyer, PhD

CONTACT

6176434897; mnyer@mgh.harvard.edu

Franklin King, MD

CONTACT

fking@mgh.harvard.edu

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: March 27, 2026
• First Posted: May 4, 2026
• Study Start: April 1, 2026
• Primary Completion (Estimated): April 1, 2027
• Study Completion (Estimated): April 1, 2028
• Last Updated: May 4, 2026

Record last verified: 2026-04

Data Sharing

• IPD Sharing: Will not share

Locations

US (2)