`Special K' drug at centre of depression treatment
Doctor says innovative method could help difficult-to-treat cases
Ketamine, a common anesthetic drug that has another life as a psychedelic club drug called Special K, has moved into the mainstream as an innovative and potentially game-changing treatment for depression.
It will be front-and-centre at a new clinic at The Royal in Ottawa.
Esketamine, a form of the drug delivered in a nasal spray, and ketamine are key treatments being offered at the new BMO Innovative Clinic for Depression at The Royal's Institute of Mental Health Research.
The clinic, aimed at helping people with difficult-to-treat depression, is supported by a $2-million donation from BMO: the single largest corporate gift in The Royal's history.
The clinic will give hope to those whose depression has not responded to other treatments, said Dr. Jennifer Phillips, interim scientific director at The Royal's Institute of Mental Health Research. Patients who meet the requirements will be referred to the clinic through specialists at The Royal or The Ottawa Hospital.
The treatments will be integrated with research with a view toward additional innovative treatments in coming years, Phillips said.
“About 30 per cent (of patients) find their symptoms don't respond to conventional antidepressant medication,” she said.
For those patients, for whom depression can be life-altering and even life-threatening, ketamine is now seen as an important option.
Esketamine, the nasal spray approved for use by Health Canada, elicits a higher response in patients than conventional antidepressant treatments, Phillips said.
Phillips calls it a “game-changer,” in part because of its ability to relieve depression in many people who have not previously responded to treatments and also because of how quickly it works.
“If this works well, we can see a dramatic transformation,” she said. “(Patients) may have lost all hope; they may be thinking about suicide. After treatment, those thoughts go away.”
The drug is considered an important innovation in the way depression is treated at a time when demand for treatment of mental illness, including depression, is on the rise.
Conventional antidepressants work by changing the level of serotonin and norepinephrine in a person's brain. Both are linked to mood and feelings of well-being.
Ketamine works on the neurotransmitter glutamate, which plays a key role in cell signalling in the brain.
Phillips says researchers are still studying exactly how it works, but it increases neuroplasticity enabling the brain to form new pathways or connections.
Ketamine and Eskatamine appear to do so significantly more quickly and broadly than conventional antidepressants.
“The discovery of the antidepressant effects of ketamine has been a paradigm shift. They are definitely very exciting because they work differently,” Phillips said.
The Royal's new clinic comes at a time when a growing number of private clinics across Canada are offering ketamine therapy for depression and other mental illnesses.
Some already exist in Ottawa. The latest, run by the Canadian Centre for Psychedelic Healing (CCFPH), is to open on Sparks Street later in June.
It will be the first in the city to offer ketamine-assisted psychotherapy, says Dr. Neel Chadha, CCFPH'S medical director and an Ottawa family physician.
The clinic offers ketamine, administered orally, along with psychotherapy to treat depression, anxiety, PTSD, trauma, addiction, substance use disorder and eating disorders.
The two-hour sessions, in which therapy begins once patients reach a “dissociative state,” cost about $715. An assessment is covered by OHIP, but the treatment is not, although some private health insurance plans do cover it.
The company says more than 93 per cent of patients showed improvement in their anxiety and depression scores after undergoing treatment.
The company describes KAP as a “holistic therapy that can allow a person to open up a new perspective on their mental health, emotions and relationship, providing an opportunity for lasting change.”
It also operates clinics in Thunder Bay and Sault Ste. Marie. More information is available at ccfph.com
With the rise of private ketamine clinics, some researchers in the United States have warned that not enough is known about the use of the drug to treat depression and other mental health disorders and its use should be restricted to clinical trials and academic settings where it can be studied further.
That is one of the goals of The Royal's new clinic, Phillips said.