What is Ketamine Therapy Used for and How It Can Help Canadians

Ketamine has been a staple in medicine since FDA approved it in 1970 as an anesthetic. But in recent years, we’ve seen a renaissance in its application, especially in the realm of mental health. As a family physician with nearly a decade of experience with ketamine therapy, I’ve had the privilege of seeing its potential firsthand.

At Field Trip Health, we use ketamine treatment to treat conditions like treatment resistant depression, generalized anxiety disorder, post traumatic stress disorder, and chronic pain. For many of my patients, it’s become a valuable option when other treatments like selective serotonin reuptake inhibitors (SSRIs) haven’t quite done the job.

So, let’s clear up the misconceptions and take an honest look at what ketamine therapy can really do.

Ketamine Therapy for Mental Health Conditions

You know, in my years of practice, I’ve seen many patients struggling with various mental health conditions. It can be like they’re carrying a heavy backpack, day in and day out. 

Treatment-Resistant Depression and Ketamine Therapy

Depression can sometimes be difficult to treat. In fact, data suggests around one third of cases may be considered treatment resistant, where they do not respond to two or more medication trials. Sometimes, it feels like we’ve tried everything in our medical toolbox, but nothing seems to work. That’s where ketamine therapy can help, especially for treatment-resistant depression.

I remember one patient who had been battling major depressive disorder for years, trying various selective serotonin reuptake inhibitors (SSRIs) with little success. Within a few sessions of ketamine infusions, she reported feeling lighter, more hopeful, with significantly reduced depressive symptoms.

Ketamine works differently from traditional medications for treating depression. It’s like a key that fits into a special lock in the brain – the N methyl D aspartate receptor. This interaction sets off a chain reaction, promoting the growth of new synaptic connections in nerve cells. It’s a bit like your brain deciding to build new roads, bypassing the old, worn-out paths that led to depression symptoms and suicidal ideation.

Anxiety Disorders and Ketamine Treatment

Anxiety is another condition patients struggle with. It’s a bit like having an overactive car alarm in your mind – always on high alert, even when there’s no real danger.

Ketamine therapy has shown promising results in managing various psychiatric disorders, including generalized anxiety disorder. I’ve seen patients who’ve lived with constant worry start to feel a sense of calm they haven’t experienced in years.

One gentleman came to me with severe social anxiety. He described it as feeling like he was constantly on stage, under a spotlight, with everyone judging his every move. After a few ketamine-assisted psychotherapy sessions, administered in a controlled medical office setting, he noticed he could go to the grocery store without his heart racing.

The rapid-acting nature of ketamine is particularly beneficial here. Unlike traditional anti-anxiety medications that can take weeks to kick in, ketamine often provides relief within hours or days.

PTSD Management with Ketamine-Assisted Therapy

Post-Traumatic Stress Disorder (PTSD) is characterized by intrusive traumatic memories, re experiencing, hyperarousal, hypervigilance, and mood disturbance. Traumatic memories keep popping up, disrupting daily life. Ketamine therapy, especially when combined with psychotherapy, can help rewire these mental pathways.

I recall working with a first responder who struggled with severe PTSD. Loud noises would trigger intense flashbacks, making even a trip to the mall a harrowing experience. He tried many medications, therapies and treatment centres for over a decade. We started ketamine-assisted therapy, and it was like we were able to access and reprocess those traumatic memories without the intense emotional charge.

He described it as finally being able to put those memories in a box on a high shelf – still there, but no longer dominating his life. The dissociative experience during ketamine therapy allowed him to view his trauma from a different perspective, making it easier to process and integrate.

This approach, involving repeated dosing under the supervision of health care providers, has shown promising results in clinical trials for treating PTSD and other mood disorders.

Addressing Suicidal Ideation through Ketamine Interventions

One of the most challenging aspects of mental health treatment is suicidality, often requiring immediate intervention.

Ketamine’s rapid-acting nature makes it a valuable tool in these critical situations. I’ve seen patients who came in with severe depression and suicidal thoughts experience a significant reduction in these feelings within hours of ketamine therapy. Evidence suggests ketamine can provide rapid reduction in suicidal ideation. 

When I started treating patients with ketamine for mental health conditions, often patients would be in hospital with suicidal thoughts. One patient described her suicidal thoughts as a constant, deafening noise in her head. After her first ketamine therapy session, she reported that the noise had quieted to a whisper. 

It’s important to note that while ketamine can provide rapid relief, it may not be a standalone solution. At Field Trip Health, we always combine it with a comprehensive approach to mental health care and therapy for the best outcomes.

This approach, supported by clinical trials, offers hope for patients with severe mental health conditions who haven’t responded to traditional medications.

Ketamine Therapy for Chronic Pain Management

When most people think about ketamine therapy, their minds often jump straight to mental health. For the right chronic pain patient, ketamine can be a powerful tool in the toolkit.  

Types of Chronic Pain Treated with Ketamine

Chronic pain can come in many forms, and I’ve seen ketamine therapy make a difference in quite a few of them.

Take fibromyalgia, for instance. I had a patient who described her pain as “feeling like I’m wearing a suit made of lead.” Traditional pain medications barely took the edge off. But after ketamine infusion therapy, she said it was as if someone had lightened the suit. She could move more freely, sleep better, and even started enjoying her garden again.

Then there’s neuropathic pain. It can be like your nerves are sending false alarms to your brain, screaming “Fire!” when there’s not even a spark. I remember working with a woman who had neuropathic pain. She had chronic back pain with burning and shooting symptoms despite multiple medication trials and therapy. After ketamine therapy, administered in low doses under medical supervision, she reported a significant reduction in symptoms that made her more functional and allowed her to be more active. 

Complex Regional Pain Syndrome (CRPS) is another condition where I’ve seen ketamine make a real difference. For some, they can describe it like the pain dial in the brain is stuck on maximum. One of my patients with CRPS said it felt like her arm was constantly on fire. Ketamine therapy, involving repeated dosing, helped turn down that dial. She could finally wear long-sleeved shirts without wincing.

Mechanisms of Ketamine in Pain Relief

Now, you might be wondering, “How does ketamine do all this?” Well, let’s discuss the current medical science understanding.

Research suggests that ketamine works by affecting nerve cells and promoting the growth of new synaptic connections. This process, observed in clinical trials, may explain how ketamine helps in treating depression and chronic pain. For patients with an overlap in depression and chronic pain, ketamine may work better in that cohort.  

Ketamine can be likened to a reset button for your central nervous system. It primarily works on something called the NMDA receptor. Ketamine comes along and essentially flips that switch off for a while. The downstream effects of that action include neurogenesis and neuroplasticity, the growth of new connections. It reduces the activity of the default mode network in the brain, an automatic network that is thought to be the home of negative thought patterns in mental health conditions. 

Ketamine also seems to help with something we call ‘central sensitization.’ Imagine your nervous system is like a stereo system. In chronic pain, it’s as if someone has cranked up the volume and sensitivity so high that even a whisper sounds like a shout. Ketamine helps turn down that volume, making the system less reactive to pain signals.

There’s also growing evidence that ketamine can help reduce inflammation. This may be particularly helpful in conditions where inflammation plays a role in pain, like rheumatoid arthritis.

I like to explain this using a garden analogy. “Imagine your brain is a garden. Chronic pain is like a weed that’s taken over. Traditional pain meds are like cutting the weed at the surface – it provides temporary relief, but the weed grows back. Ketamine is more like changing the soil composition so the weed can’t thrive anymore.”

Substance Use Disorders and Ketamine Therapy

Flowing from the mechanisms of reduction in default mode network activity, enhanced neurogenesis and neuroplasticity, it seems fitting that ketamine in conjunction with psychotherapy may reduce fixed patterns of thinking and behaving including with substance use disorders like alcohol use disorder. 

Ketamine’s Role in Addiction Treatment

Substance use disorders can be difficult to treat. Standard first line medication treatments can be effective, but for some folks, it can be frustrating and often unsuccessful.

Several studies have shown that ketamine plus psychotherapy can be effective for alcohol use disorder, with a phase 2 study showing 86% abstinence rates at 6 months. Larger clinical trials are hopeful and ongoing. This echoes the anecdotes of patients treated at Field Trip Health. One of our patients had been struggling with alcohol addiction and severe depression for years. He’d try to quit, make it a few weeks, then find himself right back where he started, battling depressive symptoms. 

We decided to try ketamine-assisted psychotherapy as part of his treatment plan. He described his first ketamine therapy session “like seeing my addiction from the outside for the first time.” 

Early evidence suggests that ketamine plus mindfulness based behaviour modification may help with stimulant use disorder and our team have been awarded a grant to study ketamine-assisted psychotherapy to study this further. 

Combining Ketamine with Traditional Addiction Therapies

One thing you need to keep in mind, ketamine infusion therapy isn’t meant to replace traditional addiction treatments for alcohol use disorder – it’s more like a powerful ally. Think of it as adding a turbo boost to your car. The car still needs wheels, an engine, and a steering wheel, but the turbo boost helps it overcome those steep hills more easily.

At Field Trip Health, we combine ketamine therapy with psychotherapy and other therapies. 

The neuroplasticity promoted by ketamine – that’s the brain’s ability to form new connections – make patients more receptive to the insights and strategies they learn in therapy.

I’ve also found that the dissociative effects of ketamine can be particularly helpful in treating depression and addiction. For many patients, it provides a unique opportunity to examine their addictive behaviors from a different perspective. It helps them step outside themselves for a moment and see their patterns more objectively.

One patient described it as “finally being able to see the forest instead of just the trees.” This new perspective often leads to profound insights that we can then work with in their ongoing therapy for depression and addiction.

Watching a patient break free from the chains of depression and addiction is one of the most rewarding experiences in my practice. 

Benefits of Ketamine Therapy for Canadians

As a physician, one of the most rewarding things is seeing a patient who’s been struggling for years finally find relief. Ketamine therapy has given us a new tool to offer hope to those who felt they were out of options.

Rapid-Acting Relief for Mental Health Symptoms

One of the most exciting things with ketamine therapy is just how quickly it can work. Traditional treatments for conditions like depression or anxiety can be a bit like watching paint dry – you know something’s happening, but it takes a while to see results, often four to eight weeks.

Ketamine, on the other hand, can deliver results much quicker, which is borne out in the clinical evidence. I remember a patient who came in with severe depression. She’d been struggling for years. After her first dose of ketamine infusion, she felt likely a completely new person. She felt lighter, and more hopeful.

Like any medicine, the effects of ketamine can vary from person to person, and it’s not suitable for everyone. But for those who do respond well, the rapid-acting nature of ketamine can be truly life-changing when treating depression.

Alternative for Treatment-Resistant Conditions

Treatment-resistant mental health conditions can be incredibly frustrating, both for patients, their families and for us as healthcare providers. One study estimates that 20-60% of common mental health conditions are treatment resistant

I’ve seen ketamine infusion therapy make a difference in treatment-resistant depression, PTSD, and even some anxiety disorders that seemed insurmountable with other therapies.

For instance, we had a patient who’d been battling PTSD for years, trying everything from SSRIs to exposure therapy. Nothing seemed to shake the constant state of hypervigilance he was living in. We decided to try medically supervised ketamine therapy like ketamine-assisted psychotherapy . After several weeks of treatment, he reported feeling calm for the first time in years.

The way ketamine works on the NMDA receptor, promotes neuroplasticity,  and reduces the default mode network activity seems to allow for a kind of mental flexibility that’s particularly beneficial in these stubborn cases.

Potential for Long-Term Symptom Improvement

Here’s something that really gets me excited as a physician – the potential for long-term improvement for patients. While the immediate effects of ketamine therapy can be dramatic, what’s really impressive is how these benefits can also last.

I’ve seen patients who, after a series of ketamine treatments, report feeling better for several weeks or even months to years. I’ll describe one example of a patient who came initially with a four year history of insomnia. It turned out he met criteria for generalized anxiety disorder and had depressive symptoms, but a large provocative factor was ongoing grief from the loss if his sister several years prior. He had tried several antidepressants unsuccessfully along with psychotherapy. After his first ketamine treatment, he reported sleeping through the night for the first time in years. During subsequent sessions he reconciled with the loss of his sister in a very moving experience for him. After the series of ketamine treatments, he remains in remission from his mental health symptoms to this day.

We often see that when patients are able to process psychological content, whether it be a trauma, past grief or a situational stressors, deeply and more meaningfully with the assistance of ketamine-assisted therapy, they often go on to have longer lasting relief of their symptoms. Other patients may require some form of maintenance treatment. Scientists feel this may be due to the brain’s synapses needing a boost for some every several weeks to months. Each patient is different and an individualized approach to care is emphasized. 

I am a fervent advocate for a comprehensive approach to long term mental health and wellbeing that includes not only medication approaches but lifestyle interventions and psychotherapy. Of course, ketamine therapy isn’t always a standalone solution. At Field Trip Health, we combine it with other treatments like psychotherapy and emphasize lifestyle and psychosocial interventions for patients.

Risks and Side Effects of Ketamine Therapy

Like any powerful drug, ketamine needs to be used with care and respect. Let me walk you through some of the things we need to keep an eye on.

Common Short-Term Side Effects

I often use the analogy that ketamine disconnects the feeling part of the brain from the thinking part of the brain. The brain’s sensory inputs are not perceived the same way, and so sometimes patients may feel spacy or floating. Some patients may experience nausea, with reported incidence in one mental health treatment group of 7.5% initially and 1.9% of all sessions. These effects can be lessened by limiting oral intake in the 2-4 hours prior to receiving the medicine. Some patients can have a short term rise in blood pressure, which is why blood pressures are taken before and after treatment. 

With a properly curated environment for the patient, taking into account the patient’s mindset (Set) and Setting, side effects and distress can be reduced. The medicine experience typically lasts at most for an hour, and treatment related side effects go away as the medicine does. At Field Trip Health clinics, we always monitor patients closely during and after treatment, especially for the first dose.

Long-Term Considerations and Precautions

Ketamine has been around since 1962 and is FDA approved, and its effects have been well-studied over the years. In high and repeated doses particularly non controlled clinical settings, there is an entity known as ketamine cystitis. In controlled clinical settings for the mental health and chronic pain patient, it has not been reported to occur. 

There are some medical conditions that we would call contraindications or may be at increased risk from ketamine treatment. Because some patients may experience generally a small rise in blood pressure ketamine, patients with uncontrolled high blood pressure, or cardiovascular conditions where a rise in blood pressure would be unsafe would be excluded. Because of the altered state of consciousness induced by ketamine, patients with psychosis, schizophrenia or active mania are excluded. Ketamine is generally avoided in pregnant patients. 

Substance dependence and abuse is another factor we consider. While the risk is low in a controlled medical setting, it’s something we always keep in mind when planning treatment schedules.

In my years of practice, I’ve seen ketamine therapy help many patients when this drug is used responsibly and under close medical supervision. It’s about leveraging our deep understanding of this medication to provide the best care possible for each individual patient.

Accessing Ketamine Therapy in Canada

Many have heard of the promising potential of ketamine treatment but aren’t quite sure how to access it. Let me explain how to access ketamine therapy in Canada. 

Legal Status and Availability

First things first – yes, ketamine therapy is legal in Canada. But its use to treat depression is considered “off-label”. It was originally designed as an anesthetic, but we’ve discovered it is a useful tool for mental health and chronic pain treatment.

Because ketamine is a generic medicine, pharmaceutical companies do not seek to benefit by submitting a dossier to Health Canada for on-label approval of ketamine for mental health indications like depression or PTSD. But – and this is important – they do allow prescribing clinicians to prescribe it if we believe it’s in the best interest of our patients.

Ketamine therapy is administered in specialized clinics, like Field Trip Health, often through intravenous infusion or ketamine nasal spray.

Most people get confused about why they can’t just get ketamine from their regular doctor. Ketamine therapy requires specific expertise and monitoring, especially when administering higher doses or using IV infusion.

Finding Qualified Ketamine Therapy Providers

So, how do you find a specialized clinic to provide ketamine therapy? Well, as ketamine therapy becomes more widely recognized for treating depression more options have become available. But it still requires a bit of legwork.

There are clinics offering ketamine therapy in major cities across Canada. In my goal to help patients across Canada, I have been fortunate to be part of the team at Field Trip Health to expand access to ketamine therapy for Canadians. The team at Field Trip Health has established clinics in many cities across Canada, including Toronto, Vancouver, and Montreal. It’s been incredible to see the impact we’ve been able to make. We’ve even launched a program that will bring ketamine therapy to your home in an effort to help those in rural communities and those that don’t yet have ketamine therapy clinics.

When looking for a provider, don’t be shy about asking questions like:

• How long have they been offering ketamine therapy to treat depression?
• What’s their success rate?
• Do they provide other therapies to help you process your experiences?

One patient found Field Trip Health by asking in his PTSD support group. Word of mouth can be a powerful tool. If you know someone who’s had a positive experience with ketamine therapy in a controlled mental health clinical setting, that can be a good starting point.

Some of the best ketamine therapy providers aren’t just focused on the drug itself. They’re passionate about mental health as a whole. That’s the approach we take at Field Trip Health, and it’s what I encourage patients to look for. We see ketamine as one tool in a bigger toolbox, not a magic wand.

Remember, while ketamine therapy can be incredibly helpful, it’s not for everyone. A good provider, whether it’s Field Trip Health or another clinic, will do a thorough evaluation to make sure it’s appropriate for you. They should be just as willing to tell you if you’re not a good candidate as they are to welcome you as a patient.

Integrating Ketamine Therapy with Other Treatments

Ketamine is a powerful medicine, but like any medicine, it’s not a panacea and should be seen as a part of a holistic approach to mental health care. On its own, yeast can’t make bread – but mix it with the right ingredients, and suddenly you’ve got something that rises beautifully and becomes so much more than the sum of its parts.

That’s how we approach ketamine therapy at Field Trip Health. It’s a powerful drug, sure, but it works best when it’s part of a well-crafted recipe for mental health. Let me share some insights on how we blend ketamine with other therapies to create the most nourishing outcomes for our patients.

Combining Ketamine with Psychotherapy

There are scientific and biological reasons discussed as to why ketamine and psychotherapy work well together – the induction of neurogenesis and reduction in default mode network leading to increased cognitive flexibility and an easier path forward for new patterns of thinking and behaving. The clinical data seems to show that psychotherapy interventions along with ketamine can allow for a higher treatment response along with a more enduring treatment response.

Patients may describe going from traditional psychotherapy approaches to then ketamine-assisted psychotherapy as shifting gears and becoming unstuck, allowing them to see things from new perspectives. Taking advantage of the increase in neuroplasticity following ketamine therapy, patients often find they can engage more deeply with the therapeutic process.

Benefits of Ketamine as Part of a Comprehensive Treatment Plan

Zooming out a bit, while ketamine can be a standalone treatment for depression, it can be thought of more like a powerful ingredient in a well-balanced recipe for mental health.

In my practice, I always emphasize the importance of a comprehensive treatment plan. This might include ketamine therapy, but also things like regular psychotherapy, medication management, lifestyle changes, exercise, socialization, bright light exposure, and even other therapies like mindfulness or yoga.

We had a patient once who was dealing with severe depression symptoms. We started them on a treatment plan that included ketamine therapy, weekly psychotherapy sessions, a mindfulness practice, and some lifestyle changes like regular exercise and improved sleep hygiene.

The right treatment plan helped reduce their symptoms rapidly, the therapy gave them tools to manage their thoughts and emotions, and the lifestyle changes helped them feel more grounded in their daily life and may have helped to prevent relapse. 

It’s important to remember that ketamine therapy, powerful as it is, isn’t a panacea. It can be effective on its own but often is like a catalyst that can make other treatments more effective. For some patients, it might be a short-term intervention to help them engage more fully with their ongoing therapy. For others, it might be a longer-term part of their treatment plan.

We also pay close attention to medication interactions. Ketamine can interact with certain drugs, so we always do a thorough medication review before starting treatment.

Integration is another key piece of the puzzle. After each ketamine session, we work with patients to process their experiences and incorporate any insights into their daily lives. It’s a bit like helping them build a bridge between the ketamine experience and their everyday reality.

At Field Trip Health, we’ve developed a comprehensive approach that combines ketamine therapy with psychotherapy, integration sessions, and ongoing support. We’ve found that this holistic approach tends to yield the best long-term results.

Is Ketamine Therapy Right for You?

If there’s one thing I’ve learned, it’s that there’s no one-size-fits-all solution in mental health. Ketamine therapy may be a good fit for some, whereas others may need a completely different solution altogether. 

Discussing Ketamine Therapy with Healthcare Providers

If you’re considering ketamine therapy, the first step is to have an open, honest conversation with your healthcare provider.

I always encourage my patients to come prepared with questions. Don’t be shy about asking about potential benefits, risks, and alternatives. Your healthcare provider should be like a knowledgeable guide, helping you navigate through the landscape of treatment options.

Remember, your medical history and current medications play a crucial role in determining if ketamine therapy is appropriate for you.

At Field Trip Health, we always start with a comprehensive assessment. It’s our way of getting to know you – your struggles, your strengths, and your goals. This helps us tailor ketamine or other treatments to your unique needs.

Making an Informed Decision about Treatment Options

Deciding on a treatment path is a bit like choosing which trail to hike. You want to consider the destination, sure, but also the journey itself.

When weighing your options, consider factors like:

1. The nature and severity of your symptoms
2. Your past experiences with other treatments
3. Your comfort level with the ketamine therapy process
4. Your support system and ability to commit to the treatment plan

It’s also worth thinking about your long-term goals. Ketamine therapy can offer rapid relief, but it’s most effective when it’s part of a broader strategy for mental wellness.

Ketamine therapy has opened new doors for many of our patients, offering hope where traditional treatments didn’t work.. But it’s not for everyone, and that’s okay. What matters most is finding the treatment approach that resonates with you and supports your journey towards better mental health.

You’re taking an important step just by exploring your options. Mental health care is a journey, and every step forward is a victory in itself.

So, is ketamine therapy right for you? That’s a decision you’ll make with the help of your healthcare providers. But whatever path you choose, know that there’s hope, there’s help, and there’s a way forward. Here at Field Trip Health, we’re honored to be part of that journey for so many Canadians, and we’re here to support you every step of the way.

FAQs

About the Author

Dr. Mario Nucci MD CCFP is a licensed Family Physician with a passion for mental health and the development of new therapies. He is actively engaged in research with a faculty associate professorship at Northern Ontario School of Medicine, and research collaborations with the University of Ottawa, University of Calgary, Lakehead University, Concordia University and Vancouver Island University.

Dr. Nucci is the founder of Bay and Algoma Health Centre in 2019, a walk-in and addiction medicine clinic. He founded the Canadian Centre for Psychedelic Healing in 2019, now operating as Field Trip Health, providing cutting edge mental health care in  Toronto,  Montreal,  Vancouver,  Ottawa,  Hamilton, Kitchener-Waterloo, Thunder Bay, Sault Ste. Marie, and at-home.