Victoria opens first public ketamine clinic for hard-to-treat depression

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Victoria’s first public ketamine clinic has opened and is using the anaesthetic – which is commonly taken as a party drug – to help patients with difficult-to-treat depression.

The Royal Melbourne Hospital’s new Advanced Interventions in Mood Disorders Clinic will administer low doses of ketamine via intravenous drips to about 50 patients with severe depression every year, and hopes to secure more funding to expand its reach.

The drug at a ketamine clinic in the US.

Clinic director Professor Chris Davey, who is also head of the University of Melbourne’s Department of Psychiatry, said those accessing the clinic had previously failed to respond to antidepressants.

Some have also tried electroconvulsive therapy, which passes electric currents through the brain.

“There are a group of patients who have tried lots of things but nothing has really worked and they are impaired by very severe depression,” he said.

“They can’t work, it has a real effect on their ability to look after themselves and to interact with family and friends. This is about trying to turn that around for them.”

He said while antidepressants typically took four to six weeks to kick in, ketamine provided immediate relief to many patients.

The downside is that its effects are more short-lived than antidepressants, with the uplift in mood sometimes only lasting a week after a single dose.

But Davey and his colleagues hope that attending the clinic six times over three weeks will kick-start patients’ recovery.

“It’s not a panacea, it’s not for everyone, but it’s another option for when other things haven’t worked,” he said.

Davey said the treatment had been effective for some patients, with one telling him it “melted away her depression”.

Ketamine works on different brain pathways to traditional antidepressants. While antidepressants work on serotonin and related neurotransmitters, ketamine works on the brain’s main neurotransmitter, which is called glutamate.

A growing body of research has found that ketamine is an effective treatment for people with hard-to-treat depression.

But it’s not yet known exactly why it appears to treat the symptoms.

This is something the new clinic hopes to answer, with consenting patients undergoing brain imaging so researchers can better understand ketamine’s antidepressant effects.

The clinic offers treatment to existing mental health patients at the Royal Melbourne Hospital and Western Health. Those referred to the clinic have failed to respond to two antidepressants during their latest bout of depression.

Therese, who does not want to disclose her real name and is among the clinic’s first patients, said the treatments had transformed her life.

“When I am depressed, I don’t want to leave home,” she said. “But after I have had this treatment I will go out with friends, go out shopping and enjoy life.”

The 59-year-old said she had experienced depression since her late teens, but it had worsened after the birth of her first child and then a diagnosis of multiple sclerosis when she was 28.

Therese has tried antidepressants and electroconvulsive therapy, which she said left her with a strong headache and some memory loss.

She said ketamine gave her a pleasant, floaty sensation and immediately dissipated her worries.

“I feel so completely relaxed after it,” she said.

Patients are monitored at the clinic for two hours after receiving treatment, as it can increase people’s blood pressure and mildly distort their sense of reality.

Therese has finished her initial acute course of treatment at the clinic and is now receiving low-dose ketamine treatments every 10 days.

It has been difficult and expensive for patients with resistant depression to access ketamine, with only a handful of private psychiatrists and clinics offering the new treatment in Victoria.

Low-dose ketamine is offered to public patients with severe depression at the Royal Prince Alfred Hospital in Sydney and Gold Coast University Hospital in Queensland.

University of NSW professor Colleen Loo, who is also a researcher at the Black Dog Institute, recently conducted a large study that compared the antidepressant effects of generic ketamine with a placebo.

It found that 20 per cent of participants who received ketamine under their skin via a small injection reported they no longer had clinical depression after four weeks of treatment. This compared with 2 per cent of those receiving the placebo.

Loo is leading an application to Medicare to create an item number to fund the treatment cost of low-dose ketamine for resistant depression.

She said it cost private patients about $350 per treatment with a generic form of low-dose ketamine and about $1100 per treatment for a patented form of the drug, including drug and treatment costs.

Most of these expenses related to the cost of carefully monitoring patients for two hours after each treatment. “It’s quite a complex treatment to use … it really needs to be done in expert psychiatrist hands,” Loo said.

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