On the streets, the hallucinogenic drug goes by the names Special K, K, KitKat, Cat Valium, Super Acid, Special La Coke, Purple, Jet, and Vitamin K.
Medically, ketamine has been used for decades as an anesthetic and painkiller, primarily in veterinary surgery, but for some Albertans, the dissociative drug has become a life-saver in their battle against depression and other mental health concerns.
“It’s literally changed my life,” said Cassandra Walker, who has had depression for most of her teens and her entire adult life.
“I went from being that person who couldn’t get out of bed, would wake up in the morning with paralyzing anxiety and I almost couldn’t tell you why.”
The Spruce Grove woman said it’s been a rollercoaster of trying different medications, endless doctors appointments, intense psychotherapy and counselling: “When I was in the thick of it, I was seeing (my therapist) anywhere from one to two times a week.”
She said trying out various antidepressants was a gruelling process.
“They slowly wean you off of it, and that takes a while. And then they slowly wean you on a new one, and that takes a while. All of which you don’t feel particularly great. And so it’s just one med after another.”
Depression is difficult to understand — even for medical professionals. At one point, a new doctor suggested she just go for walks to get over her depression. She said none of the things she tried really worked — her brain was resistant.
It wasn’t until a new physician questioned why Walker wasn’t seeing a psychiatrist and then referred her to Edmonton’s Manor Clinic that things started to turn around.
“That has been game-changing, even just in dealing with the meds.”
Manor Clinic is a private mental health practice in south Edmonton’s Heritage Valley area.
Tucked away on a tree-lined property just off Ellerslie Road and 127 Street, the property is more akin to a bed-and-breakfast than a mental health facility — but offers the serenity and solitude many patients are desperately seeking.
Last fall, Alberta became the first province to regulate psychedelic drug-assisted therapy for mental health treatments, including psilocybin and psilocin (both found in magic mushrooms), MDMA, LSD, mescaline (peyote), DMT, 5 methoxy DMT and ketamine.
The province introduced an amendment to the Mental Health Services Protection Regulation, which came into effect last month.
Dr. Yogesh Thakker, a psychiatrist and owner of Manor Clinic, said statistics show about one in eight Canadians will experience depression at some point in their life.
Of those people, Thakker said about two-thirds respond to commonly prescribed antidepressants — selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Zoloft and Lexapro — but for the remaining are one-third, traditional medications don’t work.
For people with treatment-resistant depression, Thakker said ketamine has been found to have response rates up to 70 to 80 per cent — which he said is a higher rate than with traditional medication. Results are also seen almost overnight.
“Unlike typical traditional antidepressant medications, which takes about two to four weeks to work, ketamine works within hours and the effects last up to a few days to a few weeks as well.”
For people with treatment-resistant depression, that is crucial.
“If they’re having a really bad quality of life, they are not able to even get out of bed, they have very low motivation: it significantly affects the quality of life even for them, especially if they haven’t responded to traditional antidepressant medications and psychological therapy.
“Ketamine works really, really well and very fast as well.”
There are risks: Thakker said they monitor patients closely for signs of abuse or addiction, as well as the rare chance of high blood pressure or seizures.
The duration and frequency of ketamine treatment depends on each patient. They are typically referred to the Manor Clinic by their family doctor after conventional treatments have been exhausted.
Thakker said in the past six months, his southwest clinic has treated more than 30 patients with ketamine. Most are women in their 20s or 30s, like Walker.
“We get people who have been tried on multiple antidepressant medications over many years,” he said, adding their quality of life is significantly affected.
“They don’t have any energy. They can’t work. Their social life is affected. And often they have had a history of failed treatment with even ECT — or electroconvulsive treatment — and psychological therapy as well.
“So often many patients who come here, ketamine would be the last option really. And it can be life-changing.”
Thakker said it’s an amazing feeling to see his clients responding to the therapy.
Walker began her ketamine treatments twice a week for a month, then once weekly for another month. Her doctor reassessed her treatment plan at that point.
“After those eight weeks, we decided to continue once a week for about another four weeks, and then we went down to once every two weeks.”
She said she’s now at the point where she goes in every month or month-and-a-half.
“It’s basically a booster based on when I’m feeling I need it.”
Alberta Health, the Alberta College of Pharmacy, and College of Physicians and Surgeons of Alberta have strict guidelines for drugs like ketamine, which require a secure prescription.
The prescriber has to register with the Tracked Prescription Program (TPP) Alberta. The TPP (formerly known as the Triplicate Prescription Program) has been monitoring the use of prescription drugs prone to misuse in the province since 1986. Doctors have to use a dedicated prescription form: they keep one copy on record, and another copy goes to the pharmacist.
“Because it’s a controlled medication, we have to send a triplicate prescription to the pharmacy and then medication is delivered here,” Thakker said.
Each two-hour session at the private clinic costs $200. The cost of the ketamine is separate and varies depending on the concentration and delivery method, with a month’s worth of sublingual tablets generally costing between $100 and $200. The nasal spray can cost upwards of $4,000 to $5,000. Coverage through benefits varies based on provider.
Each two-hour treatment for Walker includes having her blood pressure taken, being administered her dose ( either sublingual or intranasal) by a qualified professional such as a nurse or her psychiatrist, and then her blood pressure and status is checked every 20 to 30 minutes afterwards.
But what happens during that time? Walker said each experience with the dissociative medication is different, but she isn’t on a massive drug trip where she can see sounds and hear colours.
“A lot of people have kind of this euphoric experience for a certain period of time. I don’t generally have that. I’ve had it, I think, twice, and I really did not enjoy those experiences where it felt like you’re high, essentially.”
“It’s not a good trip, it’s not a good experience. The fact that people do this for fun is mind-blowing to me.”
Walker said usually, at the most she feels a little light-headed. She passes the time listening to music, watching a tv show or taking a nap.
“Afterwards, I tend to feel kind of like a light hangover: just like a little tired, a little groggy, my head’s a little foggy,” she said, adding her wife will drive them home and she’ll take it easy for the rest of the day.
“I tend to sleep quite a bit after ketamine treatment.
“I sleep straight through the night. Every time.”
Walker said the ketamine allowed her brain to process her antidepressants the way they were supposed to.
Ketamine therapy isn’t an either/or treatment: Walker said it supplemented the things she is already doing to look after her mental health, such as taking her medications, attending therapy every two weeks or so, and getting exercise, sleep and good nutrition.
The day after treatment, she said she feels close to 100 per cent — a stark contrast to the days when just getting out of bed felt impossible.
She describes herself as a high-achiever who did well in school and her career,”So to get to a point where I couldn’t even get out of bed was very hard.”
After beginning treatments, she said her view on everything improved: the world seemed brighter, colours more vivid. It was like a weight had been lifted.
“You don’t really realize how grey it is until you see it in colour.”
Walker said while the world is becoming more open when it comes to talking about and accepting mental health issues, there are still stigmas.
“I remember an employer of mine asking me not to let any of my employees underneath me know about it, because they would have less respect for me afterwards.
“This is the world that we’re still in, and I want to help change that. If I can help one person get out of bed and come find treatment, and know that they’re not alone and that there is a solution — then that’s what I want to do.”
Not all people are good candidates for ketamine treatment: Thakker said when screening, they have to rule out if a patient has any recent substance abuse concerns, unstable heart health or high blood pressure. It also isn’t safe for pregnant people, he said.
While ketamine is the only psychedelic Thakker is prescribing, he said research is rapidly emerging on the benefits of other drugs such as magic mushrooms and LSD.
“The future is about psychedelics and its use in mental health and it’s very, very promising, I would say, based on what evidence I’ve seen.”