Over 600 Norwegians take their own lives every year. Professional communities in Norway agree that better care is needed in the fight against the deadly stats.
Ketamine is currently approved for use for pain relief. Now the medicine is being tested in a new way – against depression and suicidal thoughts.
Interest in the treatment is also increasing among potential patients, but in the public health system, only Sykehuset Østfold offers ketamine.
He runs a personal risk
– I am a curious person and I have been working in psychiatry for a long time. Existing treatments for patients with severe depression are often insufficient for many.
This is what department head Ingmar Clausen at the district psychiatric center (DPS) in Moss says. He is a psychiatrist and pioneer of ketamine treatment in the public health system.
GREAT INTEREST: Psychiatrist Ingmar Clausen says the professional communities in Norway are interested in how DPS-Moss offers treatment. Photo: Thomas Evensen / TV 2
– We are the only public hospital that offers this treatment. Patients travel far and wide from all over the country. We’ve gotten a lot of referrals, Clausen says.
Using a medicine for anything other than what it was originally approved for is legal and is called “off label”.
– For me personally, it means that I take responsibility for everything that goes right and everything that goes wrong. It’s that simple. Because there are no higher authorities I can rely on. I take a risk. This is the price to pay for finding new ways.
– How is?
– It seems right. This is how it should be. You don’t get anything for free, Clausen tells TV 2.
– Capacity exploded
It is primarily patients with so-called treatment-resistant depression who qualify for ketamine treatment at Moss Hospital. This means that patients must have tried different drug treatments in the past with no effect.
This is the ketamine treatment:
The patient receives an individually adjusted dose of ketamine, which is slowly injected intravenously with the help of a pump.
The substance produces a hallucinatory effect which lasts for approx. 40 minutes.
During the treatment, the patient listens to calm music and is in a state of wakefulness, but at the same time dreaming.
All patients should be followed up by a psychologist or psychiatrist during the treatment period.
Ketamine boosts cognitive function and is believed to create alternate connections between essential brain structures.
“New connection points (synapses) occur between nerve cells. This helps break down depressive thought patterns and normalize dysfunctional networks in the brain.”
Explains psychiatrist and head of department at Sykehus Østfold’s ketamine unit, Ingmar Clausen.
Since opening in fall 2020, the hospital has received 510 admissions, but so far only about 200 have received treatment. The coordinator of the ketamine unit at DPS-Moss, Kari Karidatter Johannessen, tells of a violent attack.
– Capacity was sometimes blown up. The waiting time was nine months at most. It’s not justifiable to have such a long waiting period for patients with severe depression and suicidal thoughts, Johannessen says.
Suction stop introduced
Due to the large influx, DPS-Moss had to stop taking on new patients in March of this year.
ADMISSION CLOSED: DPS-Moss has decided to introduce an admissions hold for new patients from and including March 1, 2022, with reopening in October. Photo: Thomas Evensen / TV 2
– We had to restructure our offer, in order to be able to provide the treatment adequately, says Johannessen.
Intake reopened in October and now the wait time is between four and six weeks from referral to video calling, she says.
But Johannessen fears that waiting times will increase considerably in the future.
– The more well-known the treatment becomes, the higher the demand is likely to be. After all, we’re the only ones offering it publicly, Johannessen says.
She hopes more hospitals in Norway adopt ketamine treatment.
– I hope the attention the treatment receives will motivate other hospitals to adopt it. There’s a very high demand for it, and people should avoid having to travel far to get it, she says.
Risk of misuse
The head of the Norwegian Psychiatric Association, Lars Lien, says professional communities in Norway are open to ketamine treatment for depression and suicidal thoughts.
– There is open skepticism in Norway. I’m glad there are many studies underway showing more positive effects, says Lien.
But there’s still some uncertainty about the treatment, he explains.
OPTIMISM: Lars Lien, head of the Norwegian Psychiatric Association, believes that ketamine treatment is met with cautious optimism. Photo: Anne Kristine Bergem/Norwegian Psychiatric Association
– There are two things. We know too little about how long the effect lasts after treatment and we lack knowledge of the risk of abuse, says Lien.
Point out other treatments where patients became addicted after finishing treatment. Such as treatments with strong pain medications.
– Ketamine has an intoxicating effect. There is always the danger that any substance with a euphoric capacity could be abused later. Therefore, it’s important to do good research before giving it to patients, says Lien.
Fear of release
Lien does not think DPS Moss patients become addicted, as the ketamine treatment is done under controlled conditions.
– They have strict routines and hiring rules. Where one of the requirements is that patients cannot have had substance abuse problems in the past. But I’m afraid the danger of abuse may arise if you don’t hold back a bit, says Lien.
Today, there are also several private clinics offering ketamine treatments for depression. Lien fears that a free release of the offer will cause the treatment to lose credibility.
OFF-LABEL: Several private clinics and DPS-Moss provide ketamine treatment outside the approved frameworks, also known as off-label treatment. Photo: Martin Fønnebø / TV 2
– Other places can start, but it’s important to do it right where you consider all aspects of the treatment and evaluate the effect, so it’s not done “cowboy style,” says Lien.
Believe in approval
Ketamine is not currently approved in Norway for use against depression and suicidal thoughts. Østfold Hospital and other private clinics then provide this treatment to their patients “off-label”.
This means that the medicine is being used in a different context than that for which it was originally approved. This is perfectly legal, but it means that the treating doctor bears the responsibility.
There is therefore great tension as to whether ketamine treatment for depression will be formally approved in Norway. Lien believes it’s only a matter of time.
– I think it will come. We see that it has an effect on the acute phase, which is an important phase. The point is to find areas of indication that are completely clear and that we connect to what we know about, says Lien.
