It has been used to treat treatment-resistant depression in Portugal for about four years. São João now offers a therapeutic approach using ketamine
August 8, 2024
Text: Amílcar Correia
Image: Guillermo Vidal
There are now five public psychiatric services in Portugal that useketamine to treat treatment-resistant depression. 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, the Magalhães Lemos Hospital in Porto adopted the substance into its treatments, and, as of this week, the Psychiatry Department at São João Hospital in the same city has followed suit.
This new therapeutic approach was introduced at this healthcare facility by psychiatrist Pedro Sousa Martins. Drawing on his experience as an intern at a clinic in Berlin, Germany, that specializes in the use of psychedelic substances to treat depression, the doctor proposed a clinical protocol based on that personal experience.
“In 2022, I proposed a key protocol based on the international literature, which has since been backed by even more evidence,” he explains to PÚBLICO, “and it was approved by the pharmacy committee, the ethics committee, and the management of the Psychiatry Department at São João.”
Ketamine’s psychedelic properties have both served to demonize it in the past and to spark new research and applications in the present. Ketamine was originally developed as an anesthetic in the 1960s. The fact that many people reported vivid dreams upon waking sparked curiosity about its psychedelic potential.
But it was precisely during that decade—a time of counterculture amid the Vietnam War—that so-called “psychedelic” substances were banned, along with scientific research into them. Michael Pollan explains the rest in *How to Change Your Mind* ( which spawned both a book and a television series). Ketamine has reemerged in this century as a fast-acting antidepressant.
In a context where psychiatric treatments have remained largely unchanged for decades, the use of ketamine has been studied as a therapeutic approach for more treatment-resistant cases of depression, for which more traditional treatments have proven ineffective. […]
Ketamine was first used to treat depression at Beatriz Ângelo Hospital about four years ago. The results of international trials helped gather scientific evidence on the substance, leading to its inclusion in international treatment guidelines and dispelling misconceptions.
In practice, the fact that ketamine is included in the main treatment guidelines for depression in Canada, Australia, and by recognized organizations in the U.S. and the U.K. has allowed Portuguese hospitals to “offer a treatment that is already part of the recommendations, even though it is not officially approved,” explains psychiatrist Pedro Castro Rodrigues. This is an off-label use, meaning a medication is used for an indication other than the one for which it was approved.
As the coordinator of the Treatment-Resistant Depression Unit at Júlio de Matos Hospital notes, “doctors should not be limited to prescribing only what is formally approved for each indication.” Pedro Castro Rodrigues believes it is important for this treatment to be available through the National Health Service at no cost to patients, and he anticipates that new services will be created in the near future.
This use is therefore based on the body of scientific evidence resulting from clinical trials, and its off-label use is already established in the major international guidelines for treating these cases that are resistant to other therapies for depression. One such trial took place at the Júlio de Matos Hospital, leading to the conclusion that symptoms of depression were reduced in 70% of patients with treatment-resistant depression. Perhaps even more revealing was the fact that half of the patients remained free of symptoms of depression three months after the conclusion of treatment.
[…]
