No More Stigma: Unlocking Ketamine Therapy for Severely Depressed Patients

Ketamine: Why can’t severely depressed patients access this effective treatment?

Depression is a pervasive and debilitating mental health condition that affects a significant portion of the Norwegian population. Between six and twelve per cent of all people in Norway experience depression at any given time, with around 650 people taking their own lives each year. Despite the prevalence and severity of the condition, current treatment methods are often inadequate and fail to provide effective relief for many patients.

For decades, the mainstays of depression treatment have been talk therapy and antidepressant medication. However, these approaches require long-term commitment from patients, and the results are often slow and uncertain. Talk therapy can take several months to produce any noticeable improvement, while antidepressants can take weeks or even months to take effect, if they work at all. Shockingly, one in three patients with depression are not helped by these standard treatment methods.

A Paradigm Shift in Depression Treatment

Fortunately, the field of depression treatment may be on the brink of a paradigm shift, as research increasingly demonstrates the potential efficacy of psychedelics in alleviating depressive disorders and suicidal thoughts. One such psychedelic substance that has gained attention is ketamine. Initially used as an anaesthetic in surgery, ketamine was discovered in the early 2000s to have rapid and profound effects on depression in small doses.

Studies have shown that ketamine can interrupt negative thought patterns associated with depression, leading to a significant reduction in depressive thoughts. In fact, recent research has even suggested that ketamine may be more effective than electroshock therapy, a treatment often reserved for severe cases of depression. After three weeks of treatment, 55 per cent of patients receiving ketamine experienced positive effects, compared to about 41 per cent of patients undergoing electroshock therapy.

The Rise and Fall of Psychedelics

Ketamine belongs to a group of chemical substances known as psychedelics. Other psychedelics include LSD, psilocybin (found in mushrooms), mescaline, and MDMA. In the 1940s and 50s, extensive research was conducted on psychedelics, including the use of LSD to treat alcoholism in Norway. The results were promising, and many patients were treated with LSD at psychiatric treatment centres.

However, the widespread use and reports of “bad trips” associated with psychedelics led to a sudden backlash. In 1967, US President Nixon banned the use of LSD, and research into the therapeutic potential of psychedelics came to a halt. It was not until the 2000s that interest in psychedelics as a treatment for mental disorders was reignited.

The Potential of Ketamine

Ketamine‘s rapid effectiveness sets it apart from other forms of treatment for depression. By administering a lower dose to patients, they can stay awake and benefit from the drug’s impact on thinking and negative thought patterns that contribute to the depressive state. Even a short-term effect of ketamine can initiate positive processes that help patients overcome depression.

Professor Ole A. Andreassen, a neuroscientist at the University of Oslo, believes that ketamine has the potential to revolutionize our understanding of mental disorders. He argues that ketamine is not a dangerous drug and is used daily in thousands of operations. Despite the growing evidence supporting its efficacy, the Norwegian health authorities have yet to approve ketamine as a standard treatment for depression.

A Small Clinic Leads the Way

In November 2020, Østfold Hospital became the first public hospital in Norway to treat a patient with ketamine. The treatment takes place at a small district psychiatric outpatient clinic in Moss municipality, where therapists administer ketamine alongside talk therapy. However, the clinic’s use of ketamine is considered “off-label,” meaning it falls outside the drug’s approved area of use.

While several studies have demonstrated the efficacy of ketamine in treating depression, the Norwegian health authorities remain cautious and insist on more comprehensive research. The Norwegian Institute of Public Health (FHI) is reviewing all available ketamine research worldwide, aiming to establish the drug’s effectiveness and safety. This cautious approach leaves a national problem in the hands of a small clinic, creating a backlog of patients seeking treatment for severe depression and acute suicide risk.

The Challenge of Placebos and Private Clinics

One challenge facing researchers studying the effects of ketamine is differentiating between placebo effects and the drug’s actual benefits. The placebo effect, where the belief in receiving treatment itself leads to improvement, can complicate the assessment of a drug’s efficacy. Ketamine‘s psychedelic nature makes it difficult to conduct double-blind studies, where neither the patient nor the researcher knows whether they are receiving the real drug or a placebo.

Adding to the complexity, private clinics in Norway have capitalized on the demand for ketamine treatment and offer it at a high cost. These private players have created a dilemma for researchers and the healthcare system as a whole. Patients who seek ketamine treatment are often convinced of its immediate effectiveness, potentially creating biased results in studies. This underscores the importance of conducting rigorous scientific research to confirm ketamine‘s efficacy.

Editorial: Breaking Barriers for Depressed Patients

The potential of ketamine as a treatment for depression cannot be overlooked. With its rapid effectiveness and ability to address negative thought patterns, ketamine offers a glimmer of hope for severely depressed patients. Yet, the reluctance of the Norwegian health authorities to approve the drug as a standard treatment option stifles progress and denies many patients the relief they desperately need.

It is crucial for the health authorities to prioritize comprehensive research into ketamine‘s efficacy and safety. Clinical studies should include placebo controls to determine the true effects of the drug and separate them from placebo responses. While it is challenging to conduct blind studies with a psychedelic drug, it is essential to ensure the integrity and scientific validity of the research.

At the very least, the health authorities should support clinical studies and provide the necessary resources to investigate the potential of ketamine. This would allow more patients to access the treatment and generate more robust evidence about its long-term effects and safety.

Additionally, the reliance on a small clinic in Moss municipality to handle the demand for ketamine treatment emphasizes the need for a coordinated and comprehensive approach at the national level. Depression affects individuals across the country and demands a response that is equitable and accessible to all.

Conclusion and Advice

Depression is a serious and widespread condition that demands innovative and effective treatment options. The potential of psychedelics, particularly ketamine, to provide rapid relief for severely depressed patients should not be ignored or delayed due to bureaucratic caution.

To support the mental well-being of the Norwegian population, it is imperative that the health authorities expedite the approval process for ketamine treatment. By investing in thorough research and supporting clinical studies, the authorities can strive to provide evidence-based treatments that offer hope and relief to those suffering from depression.

In the meantime, patients should consult with their healthcare providers to explore all available treatment options. While private clinics may offer ketamine treatment at a cost, it is essential to thoroughly research and consider the risks and benefits before pursuing this avenue.

Depression is a burden on individuals and society as a whole. By advocating for the prioritization of effective treatments like ketamine and fostering a supportive and understanding environment for those with depression, we can work towards breaking down barriers and providing the help and relief that severely depressed patients urgently need.