SUNDRE – Although not a silver bullet solution that will work for every scenario, the ketamine clinic started in Sundre a few years ago by a local physician is already showing promise on addressing treatment-resistant depression and yielding positive outcomes for patients.
Dr. Jonathan Somerville, who is on the team of doctors with the Greenwood Family Physicians, decided to introduce the clinic at the Myron Thompson Health Centre three years ago.
“The reason was ketamine is an emerging treatment for resistant depression and PTSD,” Somerville told the Albertan during a phone interview.
“Some of the other treatments that are traditionally used for resistant depression would be things like ECT, which is electroconvulsive therapy, or TMS, which is transcranial magnetic stimulation,” he explained.
“Those are really good treatments, but they’re not available in rural settings.”
However, ketamine is more accessible to family doctors who work in general practices in rural communities, using the substance for situations such as procedural sedation, he said.
“We’re comfortable with using it; we know how to use it safely,” he said.
“And so to me it seemed like a great idea to create a program where we could use ketamine to treat depression in the community where patients are living (so) they wouldn’t have to be traveling to Red Deer or Calgary,” he said.
Attempting to treat depression with ketamine is an option that is considered when other methods have not been successful, he said.
“Resistant depression is typically defined as depression that does not improve after treatment with at least two traditional antidepressants and psychotherapy and someone has ongoing symptoms.”
Ketamine has been emerging as another option to address treatment-resistant depression over the past 15 years or so, he said, adding that while there are sublingual or intranasal ways to deliver a dose, it is usually administered intravenously in rural settings like the Sundre hospital.
In just a few short years, Somerville reports there have already been some good outcomes.
“We’ve seen a lot of success,” he said.
“We’ve seen some really positive responses in a number of patients who generally are involved with psychotherapy, where they’re working with counsellors who are comfortable supporting patients getting ketamine,” he said.
Describing how ketamine works, he said the substance “kind of brings your brain back to a place where there’s more plasticity and it can adapt to changes and allow you to integrate the things that you’re learning about in therapy.”
More simply put, he added, “It kind of just makes the therapy that you’re receiving more effective.”
So far, the treatment is showing promise.
“We’ve had really good outcomes where patients have been able to return to some part-time work after being disabled for a period of time,” he said.
“Of course, it’s still not the silver bullet; it’s not for everyone, and some people respond better than others,” he clarified.
“It’s still really important that people are seeing psychiatrists and continuing work on other fronts,” he said. “But we have definitely seen good effects and good outcomes.”
Responding to a question about the opioid epidemic that has unfolded in recent years as a result of that painkiller being heavily relied on by extension leading to serious ramifications and whether ketamine might pose a similar risk of developing dependency or even addiction, he said, “Theoretically, there could be a risk. But it doesn’t produce dependence in the same way that opioids do.
“And the treatment is only used as a short-term goal; it’s given during the course of their involvement in the clinic,” he said.
“In this setting in the ketamine clinic, it’s really just used as a one-time treatment option.”
The ketamine is delivered through approximately half a dozen infusions over the span of three to four weeks. Each infusion takes approximately 40 minutes, he said.
“So they usually end up being in the clinic for two to three hours, based on the time to get it started and run the infusion, and then monitor,” he said.
And it certainly isn’t done over the counter on a patient’s request.
“This is done usually with the request of a psychiatrist,” he said.
“It’s for patients who are seeing a psychiatrist and are not responding the way that they hope,” he said, adding there is a discussion with the mental health specialist first.
“We’ll discuss whether ketamine is an option, and if they recommend it then we’d go ahead and try it.”
Somerville said ketamine is a great option for supporting critical psychiatric needs in a rural setting.
“I hope that more rural sites would become comfortable with using this appropriately.”
A press release issued by Alberta Health Services said the program could potentially become a template for other rural communities to consider adopting.
Sundre’s ketamine infusion program has drawn patients from across central Alberta – and demand for this treatment has led to a similar program rolling out in Red Deer. That program launched earlier this year. Initially for inpatients only, it has since been expanded to include outpatients, reads part of the statement.
“We’ve had overwhelming interest and, typically, very impressive patient responses to the treatment,” Dan Boomer, unit manager in Recovery Alberta at Red Deer Regional Hospital, Units 34 and 36, was quoted as saying.
Offering additional insight on the outpatient service, Somerville said that many programs would see the patient admitted to the hospital for the duration of the treatment. So day in and day out in between infusions, the patient would remain at the hospital.
“In our case, you are still at home – you show up for your appointment, you have your ketamine and you go home,” he said.
“But accessing the program still requires being part of a psychiatric treatment plan.”
Chantal Crawford, site manager at the Myron Thompson Health Centre, said in the presser that she’s seen a remarkable change in Sundre-area patients after one or more infusions.
The infusions are given in the health centre’s emergency department by nurses who’ve been trained on ketamine policies and procedures. Unlike some other ketamine treatment programs, participants are able to come in as outpatients.
“We have patients saying they’ve gone out for supper for the first time in years and telling us we’ve changed their lives,” says Crawford.
“We’re putting smiles on people’s faces.”
