It has been used in the treatment of the most resistant depression in Portugal for around four years. São João already offers a therapeutic approach with ketamine
August 8th, 2024
Text: Amílcar Correia
Image: Guillermo Vidal
There are already five public psychiatric services in Portugal that use ketamine[or ketamine] to treat more resistant depressions. The Beatriz Ângelo and Júlio de Matos hospitals and the Janelas Verdes Clinical Center, in Greater Lisbon, were the first to do so. More recently, it was the turn of the Magalhães Lemos Hospital, in Porto, to adopt the substance in its treatments and, since this week, the Psychiatry department of the São João Hospital, in the same city.
This new therapeutic approach was introduced at this health establishment by psychiatrist Pedro Sousa Martins. The doctor drew on his experience as an intern at a clinic in Berlin, Germany, dedicated to the use of psychedelics to treat depression, to propose a clinical protocol based on this personal experience.
"I proposed a fundamental protocol, in 2022, based on the international literature, which has so far accumulated even more evidence," he explains to PÚBLICO, "which was approved by the pharmacy committee, ethics committee and board of directors of the São João Psychiatry service."
Ketamine's psychedelic properties have served both to demonize it in the past and to spark new research and uses in the present. Ketamine was originally an anesthetic drug in the 60s. The fact that several people reported intense dreams when they woke up sparked curiosity about its psychedelic potential.
But it was precisely in that decade, rocked by a counterculture in the midst of the Vietnam War, that the so-called "psychedelic" substances were banned, along with their scientific research. Michael Pollan explains the rest in How to Change Your Mind (which led to a book and a TV series). Ketamine is making a comeback in this century as a fast-acting antidepressant.
In a context where psychiatric treatments have been stabilized according to a constant batch of substances for decades, the use of ketamine has been studied as a therapeutic approach in more resistant cases of depression, for which the more classic antidotes have been ineffective. [...]
Ketamine was first used to treat depression at the Beatriz Ângelo Hospital around four years ago. The results of international trials have helped to gather scientific evidence about the substance, to have it considered in the international guidelines for treatment, and to dispel dogmas.
In practice, the fact that ketamine is part of the main treatment guidelines for depression in Canada, Australia and recognized bodies in the US and UK has allowed Portuguese hospitals to "offer a treatment that is already part of the recommendations, despite not being officially approved," explains psychiatrist Pedro Castro Rodrigues. This is an off-label use, i.e. a drug that is used for an indication other than that for which it was approved.
As the coordinator of the Resistant Depression Unit at Júlio de Matos Hospital says, "doctors don't have to limit themselves to prescribing only what is formally approved for each indication". Pedro Castro Rodrigues considers it important that this treatment exists in the National Health Service, at no cost to patients, and predicts that new services will be created in the near future.
This use is therefore the result of the accumulation of scientific evidence from clinical trials and its off-label administration is already established in the main international guidelines for the treatment of these cases that are more resistant to other therapies for depression. One of these trials took place at the Júlio de Matos Hospital and concluded that symptoms of depression were reduced in 70% of patients with resistant depression. Perhaps more revealing was the fact that half of the patients remained without signs of depression three months after completing the treatment.
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