Psychedelics have a bad reputation, linked to their recreational use in the 1960s. But they are increasingly being used in healthcare. Ketamine, in addition to being a safe anesthetic, is—at different doses—also an antidepressant that “makes the brain more plastic.”
Text by Marta Martins Silva
Photo by Sérgio Lemos
[Carla Mariz] has been a clinical psychologist for 25 years, and after a year and a half on the team at Júlio de Matos Hospital—where she founded a therapeutic unit using ketamine—she joined Portugal’s first private clinic offering psychotherapy assisted by this psychedelic, with branches in London, Oslo, Trondheim, New York, Los Angeles, and Toronto.
When did you start using ketamine in your professional life?
I was working in the geriatric psychiatry department at Júlio de Matos Hospital when I was invited to join a project that was just getting started: the Unit for Treatment-Resistant Depression Using Ketamine. We developed and implemented that unit, and in the meantime, together with other partners, we launched the private project The Clinic of Change, the first private clinic for ketamine-assisted psychotherapy. When it opened, I left that unit at the public hospital and devoted myself entirely to the private clinic specializing in psychedelics. However, I continue to work at the Lisbon Psychiatric Hospital Center (formerly Júlio de Matos) in the Geriatric Psychology department, providing care for caregivers of patients with dementia.
What fascinated you about ketamine to the point that you joined the founding team of The Clinic of Change?
What fascinated me and made me fall in love with this approach was the possibility—and I see this every day—of a significant improvement in the lives of the people I work with; It is well known that ketamine has a transformative effect on the brain and the mind—not only in how a person experiences and views their life and suffering, but also in how they relate to others and to the world.
What do you mean?
At first, the person experiences a state known as dissociation; they feel as if they are leaving their body, begin to have a flood of thoughts, experiences, visions, sensations, and unusual associations, and start to view themselves and their issues in a different light; they are not trapped in the unhealthy, rigid narrative that characterizes less healthy mental thinking. A depressed person cannot see or feel themselves as a person of worth; they often feel incapable of managing their life, their work, or nurturing their relationships. A person with mental health issues—whether chronic or recent—is someone who is stuck in a rigid narrative, in a mindset of hopelessness, helplessness, and a lack of affection. And ketamine allows the person to see themselves in a different light, to detach from that negative, dogmatic narrative that is at the root of their suffering. They often think: “No, I’m not really that incapable, that unloved, that uncherished.” Ketamine-assisted psychotherapy provides an experience in which the patient isn’t suffering and, as a result, is actually able to see things differently. Of course, this is only possible because it is guided within a structured psychotherapeutic process.
What does ketamine-assisted psychotherapy involve?
Through ketamine’s effect on the brain—which enhances neuroplasticity (the brain’s ability to adapt, learn, and change)—psychotherapy can take effect and facilitate deeper, more lasting changes in the patient, even beyond the medication’s effects. From a psychotherapeutic perspective, during the treatment process, the individual embarks on a journey that takes them to the root of their problems, allowing them to address these issues more effectively. What psychedelics enable, within a safe and controlled clinical setting, is an acceleration and deepening of the psychotherapeutic process. I have considerable experience with psychotherapy and psychoanalysis, and I’ve noticed that most people make remarkable progress with psychotherapy, but this progress is generally slow, and some people do not experience the desired benefits. Here, what happens is that this process is accelerated; the person is quickly placed in a very intense relationship with themselves and with the psychotherapist, and most people show considerable changes within a six-week treatment period. This treatment can be revolutionary; it allows many people who are suffering greatly—often trapped in chronic states of depression, anxiety, or substance use such as alcohol—to return to their psychiatrist and psychotherapist with new tools to cope with their problems and manage their lives.
Even when all safety conditions are met, can there still be risks?
From a physical standpoint, no. From a psychological standpoint, it is advisable that the process be supervised by individuals who are highly experienced and trained in the field of psychedelics.
But psychedelics have a bad reputation…
Psychedelics were substances that reached their peak in the 1960s, when they were used recreationally, which led to situations of extreme use and resulted in some deaths associated with that recreational use. Subsequently, a ban was imposed because the use of these substances was also linked to the counterculture of the Vietnam War; then came Nixon and later Reagan, and a ban was enacted, bringing all the scientific research that had been conducted in parallel to a halt. The beginning of the movement known as the Psychedelic Renaissance took place in 2000, with a very important study that demonstrated the effectiveness of ketamine in treating depression.
(The interview continues in the print edition.)
[The Clinic of Change is a healthcare provider registered under No. E166508, headquartered at Rua das Picoas, 12, Ground Floor, 1050-173 Lisbon, with operating license No. 22863/2023, and registered with the ERS under No. 39467.]
[Dr. Carla Mariz is a clinical psychologist, withprofessional licenseNo. 007521, issued by the Portuguese Psychologists' Association.]
