Ketamine-assisted therapy lifted me out of depression. But it remains costly — and controversial
Julian Uzielli says ketamine therapy has helped his chronic depression. Now, clinics are opening across Canada
This story was originally published in June 2021.
This First Person article is the experience of Julian Uzielli, an associate producer with CBC Radio's Podcast Playlist. For more information about CBC's First Person stories, please see the FAQ.
As I lean back in the leather recliner, my limbs feel heavy. The strong dose of ketamine I've just taken is making it harder to move, so I struggle to put on my headphones and eyeshades. Soothing music lulls me into deep relaxation, as my consciousness starts to float away from my body and into a world of swirling lights, colours and images.
I'm not at a new-age music festival, or in a seedy underground drug den. This fully-legal experience is taking place under medical supervision at Field Trip Health in Toronto, a clinic that offers psychedelic-assisted therapy for those suffering treatment-resistant mental illnesses like depression and PTSD.
The clinic, which was the first of its kind in Canada, opened last year. Since then, similar clinics have opened in Quebec, Alberta, Saskatchewan, B.C., and Nova Scotia.
Ketamine was first approved for use in Canada and the U.S. as a general anesthetic more than 50 years ago. Since then it has gained a reputation as a party drug, with names like Special K or Vitamin K.
Today, it's increasingly being used as a fast-acting and effective treatment for depression. But it isn't without controversy.
I've dealt with bouts of depression and suicidal thoughts for about as long as I can remember. By the fall of 2020, after months of isolation due to the COVID-19 pandemic had taken their toll, my depression was as bad as it had ever been.
I was no longer able to function normally. I struggled to perform simple tasks and lacked the motivation to take basic care of myself. Increasingly vivid thoughts of suicide began to play on a loop in my mind.
I was ready to try just about anything.- Julian Uzielli
"A bad day was you not being able to get out of bed," said my wife Danielle. "Literally being so depressed that you cannot move."
It was in this state that I first came across the Field Trip Health clinic's website. I was dubious at first. I'm usually skeptical of anything you might lump under the "alternative medicine" umbrella, and the website's use of modern-wellness phrases like "your healing journey" raised some red flags.
And besides, I was ready to try just about anything.
Medically sanctioned drug trip
The treatment took place over three weeks, consisting of six ketamine sessions with un-medicated talk therapy sessions in between. Each ketamine session lasted two to three hours.
At the beginning of each session, I was handed a paper cup holding the ketamine tablets. I would let them dissolve in my mouth and swish for about 10 minutes.
As the medicine took hold, I felt as if my consciousness was separated from my body. It reminded me of "the sunken place" from the 2017 horror movie Get Out, except instead of being scary, it was relaxing and serene.
The experience was heavily influenced by the music, which is carefully chosen by the therapists. When it swelled to a crescendo, I felt as if I was rising with it, on the tip of a rocket blasting into space. When it calmed down, I felt like I was floating.
By the end of the three weeks, I felt like a new person. - Uzielli
Bizarre as it may sound, this experience had a huge impact on my mental health. After the first session, I felt my mood improve. After the second, I felt my perspective on life improve as well. By the end of the three weeks, I felt like a new person.
Of course, like any medical procedure, this treatment doesn't work for everyone. And there are some mental and physical conditions that can disqualify you, such as schizophrenia or uncontrolled hypertension.
But for me the ultimate effect was being able to resolve my issues and heal my mental wounds — not merely bandage them, as I had been doing with conventional antidepressants.
How it works
When I asked Dr. Yuliya Knyahnytska how ketamine works as an antidepressant, she smiled and laughed.
"The very, very simple answer is we actually don't know, because it works on so many levels," she said.
Knyahnytska — her patients call her Dr. K — studies ketamine's effects on depression. She's a clinician-scientist at the Centre for Addiction and Mental Health (CAMH) in Toronto.
When given in a clinical or therapeutic setting, she said, ketamine is able to safely and effectively relieve symptoms of depression in mere hours.
But scientists don't yet fully understand how or why it's so effective.
One theory has to do with synaptic plasticity — the brain's ability to form new connections and repair existing ones. Ketamine is known to spark a surge of glutamate, a neurotransmitter present in over 90 per cent of the synapses in the human brain.
"It results in the production of new connections and it improves connectivity of the brain," she said. "How exactly does it do it? We don't know yet."
Dr. Ishrat Husain, a clinician scientist and psychiatrist at the Centre for Addiction and Mental Health in Toronto, told The Current in March that while some studies of psychedelic treatments including ketamine are promising, they should be viewed with "a critical lens."
Many studies involve a small number of patients by clinical trial standards, he said, and often do not contain a placebo group, or comparisons with standard available treatments.
Barriers and concerns
Given what is and isn't currently known about the drug, scientists have mixed feelings about the recent surge in private ketamine clinics.
The lack of regulation and the lack of oversight may unfortunately result in some harm to patients.- Dr. Yuliya Knyahnytska
"This one is very tricky. People need treatment," Knyahnytska said, noting the pandemic has driven depression rates to alarming levels.
"It's understandable that people are looking for treatment and access is difficult and people need something to feel hopeful about."
Knyahnytska noted that when misused, ketamine can be addictive and can have unintended consequences such as psychosis.
"It's not something which we need to take lightly. And the lack of regulation and the lack of oversight may unfortunately result in some harm to patients," she said.
And there's another catch: the cost.
My treatment set me back $4,700. It was worth it, but I know how privileged I am to be able to shell out that kind of cash in the first place.
Other clinics I looked up in Toronto had similar prices. A handful of hospitals have begun setting up grant-funded programs that are free to patients, but the waiting lists can be months long.
'A different person'
Five months after I finished the program, the positive changes have stuck — for now.
I no longer struggle to get out of bed and I feel motivated to take care of myself. I have a more optimistic outlook, and I've been planning for the future — something that once seemed pointless to me. And the people around me have taken notice.
My parents were "gobsmacked." My wife says I'm like "a different person." My therapist even went so far as to use the word "miraculous."
Without long-term research on the effects of ketamine therapy, there's no guarantee my depression won't return at some point.
But I've learned first-hand how incredibly powerful this treatment can be. So if and when my depression does return, I'll be ready for it.
About the producer
This documentary was mixed and edited by Andrew Friesen, with Acey Rowe. It contains clips from Bojack Horseman, Trainspotting, 'Pass into Silence' by Iceblink, the Harvard Divinity School, The Doctors, Al Jazeera, Vice, ABC and City News.
If you're in crisis and need help, you can visit the Canada Suicide Prevention Service online, call 1-833-456-4566, or you can send a text to 45645.