Can you get ketamine for depression in New Zealand?

Warning: This story discusses themes of suicide and depression

Todd Hilleard tried half a dozen different antidepressants before turning to prescription ketamine.

Nothing shifted the severe depression and intrusive thoughts of suicide that started in 2010 after Hilleard responded to an incident as a police officer. He attempted to disarm a woman with a gun to her head only to have her turn the firearm on him.

The Christchurch earthquake where he was a first responder felt more pressure on his mental health.

"My body went into a permanent fight or flight response mode," he said, following the 12 hours he spent digging for earthquake survivors.

Now, 14 years later and after six months of taking a slow-release ketamine capsule every few days, Hilleard's depression has started to lift. The onslaught of suicidal thoughts have dissolved unless he is specifically triggered.

"I'm grateful to be on this because I have tried everything else," said Hilleard, a small business owner in Papamoa and father of two. "The anecdotal evidence is that it is working for me and I don't think it is anything anyone needs to be scared of."

Hilleard's success with ketamine is possible because of Anteris, the only clinic in New Zealand willing to prescribe ketamine for mood disorders despite growing evidence the drug can quickly and safely treat so-called treatment resistant depression.

Ketamine is already routinely used as an anaesthetic in New Zealand's emergency departments and surgery rooms as well in veterinary settings. However, it is more widely known as the party drug "Special K" that was at the centre of actor Matthew Perry's death last year.

The Friends star was using the drug to treat depression but an autopsy revealed he was illegally dosing himself at home. So far, five people have been charged in connection with his death.

Anteris, located in Tauranga, is run by Dr Caleb Armstrong, a psychiatrist who believes ketamine should be more widely available to the around 100,000 New Zealanders not responding to conventional treatment for depression.

"Some people go from being very impaired with their depression to being fairly symptom free within a couple months," said Armstrong, noting a 60 percent success rate of ketamine with treatment-resistant depression, depression that hasn't budged after attempts with at least two different antidepressants.

Medsafe has approved ketamine as an anaesthetic and it can be prescribed off-label for depression. The clinic is currently working with around 80 patients and has treated about 300 people since it opened in 2017.

Anthony, a 38-year-old patient of Armstrong's, described prescription ketamine as "psychological resuscitation" after years of depression.

"I had a lack of motivation, inability to experience any pleasure, having suicidal ideations from time to time," said the Auckland resident who works in public health.

Anthony said he didn't mind the short-term psychedelic side effects that can be off putting to other patients (but sought after by illicit drug users). He took it consistently for about a year and now only takes it when he feels he needs it.

"Ketamine is bit of opposite land where drugs that can be abused like fentanyl, people take it and they rapidly become addicted," said Armstrong.

"What we see with ketamine is the opposite of that. They get used to the side effects but after a while they want to take it less frequently or reduce the dose."

Conventional antidepressants take weeks to take effect where studies show ketamine can have an impact within 24 hours.

It does this by upping the brain's ability to form new connections, according to a 2019 study from the University of Auckland, which added to a pile of new evidence supporting ketamine's effectiveness.

Although, longterm benefits and side effects as well as ketamine's impact on developing teenage brains are still unknown.

So, why aren't more medical professionals in New Zealand willing to prescribe it? Armstrong believes there is a lack of experience and confidence in the mental health community towards ketamine.

Armstong, who went to medical school at the University of Auckland, first encountered ketamine in emergency rooms where it was used safely as an anaesthetic including with children.

He became a psychiatrist in 2012 and found mentors in Australia, where ketamine is more commonly used for depression, to help him establish his clinic in Tauranga.

The US approved ketamine as a treatment for depression in 2019. Already there are hundreds to thousands of day clinics offering services such as intravenous infusions as well as luxe residential programmes.

Professor Paul Glue from the University of Otago, who studies ketamine, believes New Zealand psychiatrists are growing in their understanding of the drug's usefulness but isn't aware of anyone else prescribing it.

Glue said he met Armstrong several years ago when he was preparing to open Anteris and called him a "good quality psychiatrist".

Another factor preventing greater access to ketamine for depression is cost, which Pharmac does not subsidise.

The first three months of treatment at Anteris, a private clinic, is $7500, including an initial assessment, monitoring to determine the right dose and the medication. That is set to rise to $9500 so patients can also receive therapy along with their ketamine.

"It helps us to help the person holistically over the course of those three months," said Armstrong.

Patients must travel to Tauranga for their first appointment and leave with a month's worth of ketamine. That dose is then monitored through regular phone calls and emails with the clinic and reduced or increased as needed. The clinic works with a compounding pharmacy to create the capsules, which are mailed monthly to patients using a special courier service at a cost of about $100 to $200 a month.

"It is very cost prohibitive. I was extremely fortunate to have my family fund it for me," said a 28-year-old Auckland woman, noting that a follow up appointment with Armstrong is close to $300.

(The administration at Anteris is apparently in need of improvement. The clinic has a two star rating on Google, although most comments criticise the administration side and praise the mental health treatment).

The social stigma of ketamine being a party drug is also off-putting. "People just think you are getting high not realising there is a therapeutic use for it," said the Auckland woman, who works in commercial real estate.

She ended up taking ketamine for about a year and no longer needs it. "I think it is a really effective option," she said.