'It changed my life tremendously': P.E.I.'s new ketamine clinic could offer mental health help

A new clinic in Stratford is offering ketamine treatment to help people with mental health conditions.

Ketamine has been used as an anesthetic before surgeries for decades, but it can also be an option for those struggling with depression and suicidal thoughts — especially when antidepressant drugs and talk therapy don't work.

"Probably about 15 years ago they realized that if you use doses that are smaller than what are required for anesthesia to knock a person out, let's say, but still enough to make them kind of wonky, you can get really good results for depression," said NuVista Psychedelic Medicine psychiatrist Dr. Mark Johnston.

Health Canada approved a prescription esketamine nasal spray called Spravato in 2020 to help with treatment-resistant depression.

Johnston said the results can vary, but a majority of patients respond very well to the nasal spray, and sometimes feel better after just one treatment.

After someone receives the spray, they are left alone to relax in a quiet and dark space. Medical staff constantly monitor things like vital signs and blood pressure to make sure it's a positive experience. 

Every patient also has to have their mental health history reviewed by a psychiatrist to make sure they are a good candidate for the treatment. 

"Ketamine is not designed to be used for everyone at all," Johnston said. "Same with esketamine. We're looking for patients who [have] technically treatment-resistant depression. And what that means is by definition they have to have failed at least two antidepressants in the past." 

How it works

Brandi Martin is a nurse practitioner with the NuVista clinic. She says the device used for the treatment is very similar to any other nasal spray you might use, and delivers a single dose through each nostril.

A typical therapy session might last anywhere from 30 minutes to two hours, depending on the person. 

"Some folks will have memories of different events in their past or kind of like a flashback of sorts to an event," Martin said. 

"It's a very calming effect so most folks will voice that they feel quite calm and then some folks will kind of get into a phase where some have a bit of out-of-body experience to some degree."

I feel like I'm a better dad, I can actually have a conversation without getting overly worked up and heated.— Matthew Patterson

Matthew Patterson knows first-hand the impact traumatic experiences can have on mental health. He is a veteran of Canadian Armed Forces, and spent time as a firefighter. 

He was also involved in a serious accident that led to migraines and personality changes. He tried antidepressants and cannabis, but they weren't as effective as esketamine therapy.

"It's changed my life tremendously," Patterson said.

"I feel like I'm a better dad, I can actually have a conversation without getting overly worked up and heated and just shutting off all opinions that aren't mine."

Patterson is now a veteran ambassador with NuVista, and said the treatments have allowed him to go back to school and reconnect with his ex-wife.

Challenges with access, long-term effects

Some experts say that although esketamine can be an effective option for many people, it's very expensive and requires a lot of personal attention.

A single session at NuVista's Stratford location is $1,100, and a usual treatment plan can run over $6,000. 

Veterans and RCMP can be covered, but most people will have to pay out of pocket. 

Tyler Kaster is a psychiatrist in Toronto and medical head of the Temerty Centre for Therapeutic Brain Intervention at the Centre for Addiction and Mental Health. He said it's important to start with traditional therapies before trying ketamine because the side effects aren't as severe.

Esketamine side effects include an increase in blood pressure and heart rate, and in extreme cases, people might lose touch with reality and develop psychosis. 

"It's a treatment that is not first, second, third, fourth," Kaster said. "It's one that can be considered. However, the difficulties really are in accessing it and also the long-term side effects, and so people should ensure they're getting proper adequate care along the way."

Kaster said there are still some unknowns with ketamine and esketamine therapy, especially when compared to other treatments like antidepressants, which have been around longer.

Health P.E.I. said in a statement that it is not aware of any psychiatrists in the public health-care system who are prescribing ketamine therapy to patients. However, the agency said it would be hard to know for sure since psychiatrists don't have to share their treatment decisions. 

The health authority said it is open to emerging treatments if they are approved and follow guidelines.