The decision was made in late August. After months of deliberation and years of research, Norwegian regulatory authorities approved public funding for intravenous ketamine treatment for patients diagnosed with treatment-resistant depression. This treatment is now covered by the national health service in all hospitals throughout the country and is provided in conjunction with psychotherapy.
“This is 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 treatment option.”
Lars Lien, president of the Norwegian Psychiatric Association, as quoted by the public broadcaster NRK.
It is estimated that, in Norway, treatment-resistant depression affects about 30% of patients diagnosed with major depression. “It is important that this treatment be conducted, for now, in hospitals and psychiatric departments, and within the framework of registries or clinical studies, until more is known about the long-term effects,” said Terje Rootwelt, chair of the Norwegian agency that regulates new drugs and therapies (Beslutningsforum), in a press release.
Now the country is taking the lead, becoming the first to guarantee universal public coverage for ketamine as a generic medication whenever the diagnosis is treatment-resistant depression. At the same time, Norway’s decision sets an example in this area, one to be followed by other countries that continue to grapple with extending this treatment to universal health care.
Ketamine vs. electroconvulsive therapy
The treatment of treatment-resistant depression using intravenous ketamine is now available to all Norwegians in public hospitals. This option gained momentum in July, when the Norwegian regulator for medical products (Norwegian Medical Products Agency) issued a favorable opinion, concluding that ketamine may be more cost-effective, more effective, and less invasive than the currently recommended treatment, electroconvulsive therapy.
Another voice welcoming this historic decision is Lowan Stewart, clinical director of Axon, a private clinic that offers ketamine-assisted treatment for depression. He has been working with the substance since 2003. In 2018, he founded the clinic in Oslo.
“Ketamine is one of the most effective treatments for depression. The side effects are mild and disappear quickly. Electroconvulsive therapy poses greater risks to patients and can cause memory loss. Sometimes this is reversible, and sometimes it is not. And most patients prefer ketamine treatment over electroconvulsive therapy. Furthermore, the cost to hospitals is only half that of a single electroconvulsive therapy session.”
Lowan Stewart, as quoted by NRK.
Until now, Østfold Hospital in the Norwegian town of Gralum was the only public facility offering intravenous ketamine-assisted treatment for treatment-resistant depression. It had been doing so since 2020, as an institution granted special status by public authorities. Since then, over the past five years, approximately 400 patients with severe depression have been treated in Østfold using this therapy. “At first, it was overwhelming. We were receiving patients from all over the country,” revealed Ingmar Clausen, head of the hospital’s psychiatry department.
Approved nationwide, the off-label use of ketamine for the treatment of treatment-resistant depression will continue to be evaluated through the end of 2028.
Portugal took the lead
News of progress in the field of psychedelic-assisted therapies is coming from the far north of Europe, butPortugal was a true pioneer in this area within the European Union. It was 2021 when, at Beatriz Ângelo Hospital in Loures, the first patients began to be treated with ketamine 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 across the country. In Lisbon, the treatment is also administered at Júlio de Matos Hospital and the Janelas Verdes Clinical Center. In Porto, it is now available at Magalhães Lemos Hospital and São João Hospital.
Although a pioneer in the implementation of this treatment in the public sector, Portugal—and the National Health Service—continue to treat ketamine-assisted psychotherapy as a conditional treatment, decided on a case-by-case basis rather than as a universally guaranteed service, as is already the case in Norway.
In May of this year, the Expresso newspaper reported on nearly 600 patients with depression who had been treated using this method in Portugal. Private clinics account for the largest share. “The results are promising, ” the weekly concluded. Since 2023, The Clinic of Change has been offering psychedelic-based therapies for the treatment of treatment-resistant depression, with over a hundred success stories in the past two years.
See our psychedelic-assisted psychotherapy programs here.
