Hopes to open NHS ketamine clinic for treatment resistant depression

Ketamine is increasingly known as a party drug which is linked to serious health problems, even fatalities.But there is growing interest in Scotland in its potential to treat severe depression.One NHS Lothian psychiatrist hopes to set up a clinic by the end of the year offering the Category B drug as an alternative to electroconvulsive therapy (ECT), a treatment that involves sending an electric current through the brain.Prof Andrew McIntosh thinks it could offer another alternative to patients with the most hard-to-treat depression.
The move comes after a private clinic in Lanarkshire began offering ketamine assisted therapy to clients with treatment-resistant depression last summer.The Eulas clinic in Hamilton opened under licence from Healthcare Improvement Scotland in September and charges £6,000 for a programme of four intravenous ketamine infusions and a course of psychotherapy.Ketamine is a medical anaesthetic and while it is not licensed for the routine treatment for depression, it can be used 'off-label' by doctors and psychiatrists. Alex, who recently moved to Scotland from the United States, is one of 12 people being treated at the clinic.She has experienced periods of depression and anxiety and says she turned to ketamine assisted therapy when traditional treatments didn't help."I was crying all day long while I was working, and was very resistant to doing anything new," the 40-year-old said.
Ketamine, which is illegal on the streets, has nevertheless been used as a recreational drug for years because of its detached, dream-like effects. "I definitely had a psychedelic experience," Alex said. "You would see images, kind of feel like you're floating sometimes. "If you're reclined, you might feel like you're floating into different spaces for example. Or like you're going down a waterslide."Alex believes the infusions made her more receptive to psychotherapy."I think it makes it more palatable almost," she says. "You may see an image and you'll remember this image and then you'll talk to your therapist and they'll say: 'That's interesting, why do you think you saw that? What does that represent to you?"Alex had already tried ketamine therapy in the United States before being treated in Scotland and thinks it should be more widely available here."Before, I was really depressed," she said"Now I feel like I'm doing pretty well. I am active, I am trying new things, traveling again, kind of getting back to the person I felt like I used to be."
Sean Gillen, the director of the Eulas clinic, says patients must have a diagnosed condition and be assessed by a psychiatrist to qualify for treatment.He admits the cost of ketamine assisted therapy may be out of reach for many and hopes it will soon be available on the NHS."You're dealing with psychiatrists, anaesthetists, psychotherapists – these are real professional people and they need to be paid," he said."Most people don't have that kind of money and that's why we'd like to enter a partnership with the NHS."
Ketamine is licensed as an anaesthetic but has hit the headlines for its recreational use. It can cause serious and sometimes permanent damage to the bladder, alongside a range of other complications if misused.It was linked to the death of RuPaul's Drag Race UK star The Vivienne earlier this year. And a coroner found Friends actor Matthew Perry died of the 'acute effects of ketamine' in 2023. Esketamine, a form of ketamine taken as a nasal spray, has been approved for the treatment for moderate to severe treatment-resistant depression in Scotland but intravenous ketamine has not, though it can be prescribed 'off-label'.The Royal College of Psychiatrists has previously urged caution over the use of ketamine therapy but it is due to publish a new report on psychedelics later this year, with updated information on ketamine.
Andrew McIntosh, a professor of psychiatry at the University of Edinburgh and an NHS psychiatrist, hopes to set up a ketamine clinic at the Royal Edinburgh Hospital by the end of the year.It would be offered to patients with the most hard-to-treat depression, as an alternative to ECT.He said: "Even after taking multiple antidepressants and multiple different treatments, there's a small number of people who don't respond very well to any of those treatments, so ketamine gives them additional hope and it's been shown to be effective. "And it's an extra thing we could be doing to help our patients that is not currently available widely in Scotland."Prof McIntosh said it is not clear exactly how ketamine works to treat depression.He said: "Some people think it's because the brain becomes more plastic, more able to adapt. "Some people think it's because it alters the connections between different parts of the brain. "I think it's fair to say we don't fully understand how all the pieces of the jigsaw fit together and why it's effective, although we know it's very effective."He said the ketamine used to treat depression is very different to what people might take illegally."The ketamine that's given in clinical services is going to be a very pure form of the drug," he said. "It's going to be given under very controlled circumstances, and we are going to know that it's only the drug that's in the preparation, it's not the other things that are sometimes taken by people who use it recreationally. "The dose of the drug that is given for depression is also far, far lower than people use recreationally, so we think the risks of that are much, much lower than they are when it's taken in the community."
NHS Lothian said it was considering the use of intravenous ketamine as an alternative to ECT, but no decision had been made.Tracey Gillies, executive medical director at NHS Lothian, said recent international studies suggested that the use of IV ketamine may be a cost-effective alternative to ECT. She said the introduction of any new service had to be carefully considered, with patient safety and cost factors among those to be managed.Dr Anna Ross, a lecturer in health and social policy at the University of Edinburgh and co-founder of Scottish Psychedelic Research Group, has carried out research with the Eulas clinic. She is interested in the potential for ketamine to treat depression and addiction problems but believes psilocybin, a Category A drug found in so-called magic mushrooms, could be more effective.She said: "I've been involved in drugs policy and drugs using communities now for about 20 years, and ketamine in and of itself has not been a substance I've known to be a positive substance as such, but it's really come to the fore in the UK because we don't have access to psilocybin. "So therefore clinics like the Eulas clinic and NHS facilities are starting to look at ketamine because it already has a scheduling and it can already be used for psychedelic therapy."A Scottish government spokesman said: "Decisions on whether to prescribe a medicine are a matter for the prescribing clinician based on individual patient need and in consultation with the patient, informed by advice and guidance about the medicine."

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