The decision came at the end of August. After months of consideration and years of studies, the Norwegian regulatory authorities approved public funding for intravenous ketamine treatment for patients diagnosed with resistant depression. This is now guaranteed by the national health service, in all hospitals throughout the country, and in the context of psychotherapy.
"It's a positive day for patients with treatment-resistant depression. We finally have a new tool at our disposal. This is a group of patients who have suffered for a long time, who have remained ill for years, and who now have a new therapeutic option."
Lars Lien, president of the Norwegian Psychiatric Association, quoted by public news station NRK.
It is estimated that in Norway, treatment-resistant depression affects around 30% of patients diagnosed with severe depression. "It is important that this treatment takes place in hospitals and psychiatric departments for the time being, and within the framework of registries or clinical studies, until there is more knowledge about the long-term effects," said Terje Rootwelt, president of the Norwegian body that regulates new medicines and therapies (Beslutningsforum), in a press release.
Now the country has taken the lead, becoming the first to guarantee universal public reimbursement for ketamine as a generic medicine, whenever the diagnosis is treatment-resistant depression. At the same time, the resolution taken by Norway makes it an example in the field, to be followed by other countries that continue to struggle with the extension of this therapy to universal healthcare.
Ketamine vs. electroconvulsive therapy
Treating resistant depression with intravenous ketamine is now a possibility for all Norwegians in public hospitals. This possibility gained momentum in July, when the Norwegian medical products regulator (Norwegian Medical Products Agency) issued a favorable opinion, concluding that ketamine can be cheaper, more effective and less aggressive than the currently recommended treatment, electroconvulsive therapy.
Another voice welcoming this historic decision is Lowan Stewart, clinical director of Axon, a private clinic offering ketamine-assisted treatment for depression. He has been working with the substance since 2003. In 2018, he founded his own clinic in Oslo.
"Ketamine is one of the most effective treatments for depression. The side effects are mild and disappear quickly. Electroconvulsive therapy poses more risks for patients and can cause memory loss. Sometimes it's reversible, sometimes not. And most patients prefer to be treated with ketamine rather than electroshock. What's more, the cost to hospitals is only half that of an electroconvulsive therapy session."
Lowan Stewart, quoted by NRK.
Until now, Østfold Hospital in the Norwegian town of Gralum was the only public facility to offer intravenous ketamine-assisted treatment for resistant depression. It had been doing so since 2020, as an institution with exceptional status conferred by public authorities. In the five years since then, around 400 patients with severe depression have been treated at Østfold with this therapy. "In the beginning it was overwhelming. We received patients from all over the country," said Ingmar Clausen, head of the hospital's psychiatry department.
Approved for the whole country, off-label ketamine-assisted treatment for resistant depression will continue to be evaluated until the end of 2028.
Portugal took the lead
The news of advances in psychedelic-assisted therapies comes from the far north of Europe, butPortugal was an absolute pioneer in this field in the context of the European Union. It was 2021 when the first patients were treated with ketamine at the Beatriz Ângelo Hospital in Loures, in a Portuguese public hospital. Portugal was thus the first EU country to treat patients with ketamine in a public hospital.
Today, the use of this psychedelic has spread to other public hospitals in the country. In Lisbon, the treatment is also administered at the Júlio de Matos Hospital and the Janelas Verdes Clinical Center. In Porto, it has already reached the Magalhães Lemos Hospital and the São João Hospital.
Although a pioneer in the implementation of treatment in the public sector, Portugal - and the National Health Service - maintain ketamine-assisted psychotherapy as a conditioned treatment, decided on a patient-by-patient basis and not universally guaranteed access, as is already the case in Norway.
In May of this year, the Expresso newspaper reported that almost 600 patients with depression in Portugal were being treated in this way. Private clinics account for the lion's share. "The results are promising," concluded the weekly. The Clinic of Change has been providing psychedelic therapies to treat resistant depression since 2023, with over a hundred successful cases in the last two years.
Check out our Psychedelic-Assisted Psychotherapy programs here.
