Only one person in the Auckland District Health Board region has received ketamine as a treatment for severe suicidality: me.
According to the World Health Organization, 121 million people worldwide have been diagnosed with depression. The latest ground-breaking treatment for those 121 million is Special K, or if you’re outside of a loud dark room, ketamine. Medical grade ketamine operates on glutamate receptors—the same ones affected by alcohol, hence the feel-good effect—and its use has been referred to as “the biggest breakthrough in depression research in half a century” by Professor Ronald Duman, a neurobiologist and psychiatrist at Yale University.
Australia’s forerunner of ketamine research Professor Colleen Loo refers to it as a “quiet revolution.” Despite the hype, the psychiatric breakthrough of a generation is almost impossible to get past the medical committee at any major Australian or New Zealand hospital. Australia trialed the treatment in the early 2000s when traditional treatments had failed to work, but it has yet to be adopted as a common practice. This isn’t some backwater idea, however—the American Psychiatric Association has been vocal with their excitement about ketamine.
New Zealand has dipped into the ketamine pool more recently; it was first used to treat depression in New Zealand at the Southern District Health Board in 2010. The psychiatrist in charge was referred to as “Dr. A”, a pseudonym invoked in the aftermath because the drug was technically off-label, which is to say unapproved. The doctor was reprimanded and the work was buried from public view. Although it wasn’t exactly an international incident, it left the Health and Disability Commission very much against the use of ketamine and psychiatrists wary of experimenting with it.
So only one person in the Auckland District Health Board region has received ketamine as a treatment for severe suicidality: me. I was severely depressed and had made numerous attempts to take my life in the ward—I was placed in the Intensive Care Unit, where they checked on me every fifteen minutes and, for several weeks, had me under constant watch.
I tried all the available SSRIs and had 18 treatments of Electroconvulsive Therapy. Nothing worked. Then my psychiatrist and a senior consultant suggested ketamine infusions. They had to go through a hellish amount of paperwork to get this approved—the most difficult party involved was the separate government agency Pharmac, which determines what drugs and can and cannot be prescribed. Suffice it to say they aren’t huge fans of pumping patients full of party drugs.
Researchers know why ketamine works, but still have no idea why ECT, the traditional treatment for severe depression, does. They only have vague theories. And ketamine is a much cheaper treatment than ECT; a ketamine infusion in New Zealand costs $200, whereas ECT is closer to a grand.
I had four infusions and within a couple hours, my mood lifted considerably. During treatment I was euphoric. Never had the K-hole experience—although I did have some entertaining conversations with the clinical director, ECT doctor, nurse, and registrar. After the treatment, I no longer had thoughts of suicide, and felt good for the first time in forever.
After two weeks, my mood dropped again. This time my psychiatrist was unable to get approval from the medical committee for further infusions—a confusing decision, considering our evidence that it had clearly worked. My doctor explained it was a matter of “what people would think, and [their being] averse to risks.” Following Dr. A's debacle, no one was too keen to go rogue without the committee's approval. Despite their concerns, I had experienced none of the adverse effects.
It was then suggested I try treatments of ECT and ketamine at the same time. They were approved simply because ECT is the old reliable treatment with an established protocol. After 18 more rounds, I was well again. It was incredible. I no longer felt a devastating, debilitating, dead-eyed blankness. I felt whole again. My personality returned. According to friends, I was “normal” once more. I didn't want to die. Rather, I wanted to live.
Anxious that my mood would drop again, I asked for oral ketamine after discharge. My psychiatrist said, “We just can't do it here. We can't get it approved." Despite my experience and the international research that demonstrates that both ketamine infusions and oral ketamine are highly effective, Pharmac hasn't licensed it as a treatment for depression. The stigma attached to the drug meant it simply wasn’t allowed for my condition.
Arguments against the use of ketamine include its side effects of hallucinations, psychosis, and irrational behavior, as well as the fear that a patient will become dependent. But really, it's the reputation of ketamine as a party drug and a horse tranquilizer, coupled with the fact that it's still technically an experimental, off-label treatment, that makes it so taboo. There is also the worry that if oral ketamine is prescribed, it will offer a new channel of access for those using it recreationally.
The refusal of Pharmac and the Health and Disability Commission to approve ketamine as a treatment is an example of intransigence, a hesitation to establish new protocols allowing psychiatrists to try out new things and accomplish significant new research. The use of and research into ketamine could lead to the development of new drugs that also operate on glutamate receptors—drugs that have less stigma than Ketamine. It seems unfair to impede research into an incapacitating illness over a negative social connotation. Some people abuse drugs—but a lot more people need them to feel well, and they shouldn’t be suffering because of the choices of others.