Jordan Heath-Rawlings: What comes to mind when you first hear the word ketamine? It likely depends on how old you are or how old you were when you first learned about it. For those who go back to the 1970s, when it was first approved for use, it was a painkiller used mostly in veterinary medicine. In the 1990s, it was still known as a horse tranquilizer, but it also became a part of the rapidly growing rave scene, thanks to its disassociative properties. Of course, it was still a dangerous drug, mostly intended for large animals, and it was easily possible to take too much. Again, if you were of the age for the rave scene, you may remember the term ‘K-hole’, which was the state that partiers fell into after a heavy dose. But if you learn about ketamine now, you might hear some of that. But mostly you will hear about a rapidly evolving use for it. In smaller doses, research has begun to show, ketamine can be employed against treatment-resistant depression. What do those doses look like? I will let our guests today describe that. How does it work? We are literally learning about this in real time. We’re not quite sure exactly why it works, but it seems to. And we do know now that for some people who have been living with depression for years and years, what used to be known as a horse tranquilizer has become a literal lifesaver.
Jordan Heath-Rawlings: I’m Jordan Heath-Rawlings. This is The Big story. Julian Uzielli is an associate producer at CBC Radio who told a fascinating and also personal story recently on The Dock Project. Hey, Julian.
Julian Uzielli: Hi, Jordan. Thanks for having me.
Jordan Heath-Rawlings: I want to start with the personal side of what I mentioned, because we’re going to get into the science and the research and the whole thing is really compelling. But maybe to just set up where you’re coming from, tell me your story about how you got involved in this?
Julian Uzielli: Sure. Well, I mean, I’ve suffered from chronic depression for pretty much as long as I can remember. I was only diagnosed formally a few years ago in my early 20s, but at that point I already was pretty sure that I had been depressed for a long time. I didn’t seek professional help until I was in University, but I can remember it as early as puberty or maybe even earlier. And what that actually means is that sometimes I feel fine. I feel normal. And other times I feel just hopeless and despondent about it could be anything but about the future. Generally, I’ll feel hopeless and despondent about the future. I’ll feel powerless to change it, feel overwhelmed by stress or the pressures of life, or if there’s some specific situation that might trigger it. And essentially I just sort of feel overwhelmed by external stimuli and lose the will to live, to put it bluntly. And so I’ve had episodes of that throughout my life. And then it started to get particularly bad during the pandemic. Like, for a lot of people, it had a pretty bad effect on my mental health. And I hit basically what my therapist called as an all time low in terms of my depression. And I ended up having to take some time off work on disability leave because I wasn’t able to to function, basically.
Jordan Heath-Rawlings: And over this time, have you tried different kinds of therapy? Has you tried medication? I’m trying to get a sense of what you’ve been through, trying to help yourself out of this.
Julian Uzielli: Yeah. So the first time I went to ask someone for help, I was in University, and I probably I used to get really, really stressed around exams and final assignments and that kind of thing. So one year I think I was in second year University. I went to the student health clinic and said, I feel really depressed. I feel I need help. I need to talk to somebody. And the quality of on campus mental health services is mediocre at best. And first of all, it took me weeks to even see somebody for an intake. And then they basically just referred me to a therapist outside of the school. So I saw a therapist a couple of times in University didn’t really click. And then I tried to push it down. And I thought, I’m not really depressed. I don’t really need to see somebody. It’s just my head. I just need to get over it. And I tried to get along that way for a while and it didn’t really work. And then after I graduated, and once I had been sort of in the working world for honestly, not that long, like, about a year, I was feeling pretty bad again. And I then went to get help for real that time. And I basically have been seeing one therapist or another ever since then. And I first went on antidepressants around that time. So when I was around 25 and I’ve been on various combinations of antidepressants since then as well.
Jordan Heath-Rawlings: Can you tell me about the moment that you found Field Trip Health and you decided to give it a try? What is it, first of all, and what intrigued you about it?
Julian Uzielli: Yeah. Well, I had been feeling really low for several months. I was finding it harder and harder to focus on my work until I was taking a lot of sick days and giving very vague reasons for them. But the truth is, I was just unable to motivate myself to get out of bed and face the world. And that was happening more and more often. I was having regular appointments with my doctor to talk about my antidepressant medication because I had been increasing it due to all this stuff. And at one point he said, okay, you need to stop working, like, today because I was having particularly starting to have more and more severe suicidal thoughts and it basically made me take a leave of absence from work. And once I was off work, it sort of hit me how serious it was. Like I had had suicidal thoughts before. I had felt depressed before. I had had trouble getting out of bed before. None of that was new. But what was new this time was how severe and prolonged it was. And it was legitimized by having a doctor write a note saying you were incapable of going to work. That somehow made it feel more real this time. And so I kind of decided, like, okay, I’m doing therapy. I’m taking medication. Obviously, it’s not really getting the job done. Maybe it’s time to try something else. Over the last few years, I’ve been seeing lots of headlines and hearing occasional new stories about MDMA being used in therapeutic contexts and psilocybin magic mushrooms being used in therapy. And I’ve been hearing about this stuff here and there. I haven’t paid a whole lot of attention to it, but I thought that’s something that I haven’t tried, and it’s something that I would be interested in trying. I had no idea if it was even available, but I Googled it. I think I just Googled Magic Mushroom Therapy, Toronto. And what I found was Field Trip Health. And so they don’t do magic mushroom therapy because that’s not yet legal in Canada, but they do do ketamine-assisted psychotherapy. And so I found their website and kind of that’s how I got started.
Jordan Heath-Rawlings: Before we talk about your own journey and what happens a field trip health. Can we Zoom out a bit and talk about what is ketamine? And how has it been used in the past, both medically and recreationally? What is this drug?
Julian Uzielli: So ketamine is dissociative anesthetic. It’s actually been used fairly wisely in medical settings for at least 50 years as an anesthetic, like as a general anesthetic during surgery. And it’s also used in veterinary context, again, as a general anesthetic, where it gets there’s a common myth that ketamine is a horse tranquilizer, which is technically true because it can be used as to sedate a horse in enormous doses, but in much, much smaller doses, you can also use it for humans or dogs or cats or whatever. But from my part, that’s what I had heard about ketamine before. It was like, Isn’t that a horse tranquilizer? I didn’t know that it could be used as a therapeutic drug. I certainly had no idea that it was considered to be a psychedelic. That was new to me as well. So even though for 50 years it’s been used as an anesthetic, it’s only in the last 15 to 20 years say that researchers have really started to pay attention to its antidepressant properties, which are very effective. So unlike typical antidepressants Prozac or Wellbutrin, or something like that, these kinds of drugs take weeks to work. After you start taking them, you have to take them every day. And you only start noticing, in effect, after a few weeks. With ketamine, after one dose, you start to feel the effects within hours, and those effects can last. For some people, it can be anywhere from a few days. And for others like me, it can be months. So it’s still, as an antidepressant, it’s relatively not that well understood, but we do know a lot about it from the anesthetic side. So we know that it’s safe, and we know that it works. We just don’t exactly know how.
Jordan Heath-Rawlings: So how much research, I mean, if any, because you say it’s very recent has been done in terms of using ketamine as a treatment for something like depression?
Julian Uzielli: There’s a lot more research being done now than there was before, and it’s increasing more and more every year. Up until the mid 2000s, there was almost no research. In fact, I think there was no research being published or done on ketamine as an antidepressant. And ever since then, there was one paper and then a few people caught on, and there’s a few more papers and then a few more, and then exponentially, it’s been going up since then. So the pace is really picked up in recent years, but there’s still a lot left to learn.
Jordan Heath-Rawlings: So why did you decide to try it? And just bluntly, was it coming from a place of can’t hurt at this point? Nothing to lose?
Julian Uzielli: Yeah. Pretty much. When I decided to try it, I had pretty much convinced myself that my depression was incurable. I had been feeling some amount of depressed for well over a year, at that point. It comes in waves. Some days are worse than others, but my sort of default mode seem to be just, like, cynical and depressed and unhappy and unhopeful. And I kind of just figured, like, that’s just how I am. I’ve been taking antidepressants for years. I’ve been in therapy for years. I’m still like this. So I guess this is just my life now. So maybe I’ll just try some weird experimental therapy and see what happens.
Jordan Heath-Rawlings: So what does happen when you try this therapy and maybe slow it down and describe in detail what someone would expect if they were doing this?
Julian Uzielli: Yeah. So one of the interesting things that I learned after my own experience when I started researching the story is that the experience any patient has will vary depending on where you get it. So let me start with my own experience. And that was with Field Trip Health. They do what’s called ketamine-assisted psychotherapy. So the important thing there is that you receive a dose of ketamine. Yes. But you also receive psychotherapy in conjunction with the ketamine. And in some other settings, you just get ketamine and no psychotherapy. But in my case, the clinic is set up very much to feel like a spa. It’s very, sort of very relaxing ambience, it’s in this, like, sort of hip downtown exposed brick building, like it feels kind of like a tech startup almost. There’s potted plants everywhere and fashionable furniture. And they have, like, an essential oil diffuser in every room to make it smell nice.
Jordan Heath-Rawlings: Right.
Julian Uzielli: By the time you arrive, you will have already met your therapist. I did a virtual sort of get to know you session with my therapist beforehand just to sort of talk about what I was hoping to get out of it, and for her to prepare me for what the experience would be like. And then you show up for your first session, and they guide you into this room. And it’s a fairly small room, and it’s got a big comfy leather recliner and a small desk for the therapist to sit at. And there’s some art on the walls and carpet and sort of soft mood lighting. And they have you lie down in this big chair and they put a weighted blanket over you. And you talk a little bit with a therapist about what you want to get out of that session, if there’s anything you want to work on. And then then you are administered the ketamine. So there’s a few different ways it can be administered. They can do it through intramuscular injection. They can do it intravenously. They can do it through nasal spray. For me anyway, at this location, I used dissolving lozenges. So you discuss the dose beforehand with a nurse practitioner they have there. And they hook you up to this thing that monitors your blood pressure and your heart rate and all that. You take the tablets, you have to let them dissolve, swish them for about ten minutes. And while that’s happening, your therapist is reading you a guided meditation to kind of help you get relaxed. Over the course of the ten minutes, the medicine starts to kick in. And then after about ten minutes, you spit it out. And by that time, you’re really starting to feel the full effects. And then you lean back in the recliner. You put on a pair of eye shades, like a sleep mask. And then you put on a pair of these big Bose headphones that are connected to this specially curated playlists that they have for Ketamine therapy. And you just lie back and sort of float down stream for the next hour listening to this plan. And then the strongest effects wear off after around an hour. And then after that, you come out, as we say, you take off your mask and you talk to your therapist. You do like a therapy session right there about what you experienced, what you thought if anything came up for you, anything you want to unpack, and then you go home.
Jordan Heath-Rawlings: So when you say the effects before you talk to the therapist, are you describing are you tripping? I’m just going to ask because that’s what it sounds like.
Julian Uzielli: Yeah. Basically, I didn’t the first time because they start you, started me at a relatively low dose just to get me used to the sort of physical effects. So the first time, it just felt like if you’ve ever had general anesthetic before any kind of medical procedure, and you know, that feeling where it’s like right before you lose consciousness, but you’re starting to feel kind of loopy. It just felt kind of like that for an hour, and you feel very physically relaxed. Your limbs feel heavy. But that first session, I wouldn’t describe it as tripping, but in future sessions, I did six Ketamine sessions. And in future sessions. Yeah, definitely. That would be a good word to describe it. They call themselves Field Trip for a reason, right.
Jordan Heath-Rawlings: Right.
Julian Uzielli: They call it your journey or your voyage when you talk about it with them.
Jordan Heath-Rawlings: Okay.
Julian Uzielli: So when you’re on a higher dose, your you get visual hallucinations that could be abstract or very concrete. Like, you might see something specific, or you might just see sort of stereotypical psychedelic like shapes and colours. You can relive memories. You can have sort of these epiphanies about yourself or your life that it helps you see things in a different way. It’s very difficult to describe, frankly, but it makes your brain work in a different way for a few hours. And that can be incredibly therapeutic and effective for people who are suffering from mental illness, particularly a mental illness like depression, where one of the chief characteristics is just being locked into negative thought patterns. It kind of releases you from those patterns and allows you to think in new ways, which can be really, really eye opening.
Jordan Heath-Rawlings: I guess you’ve kind of described how the trip worked. How is the therapy you do after that different from the lots of therapy you done in the past?
Julian Uzielli: In many ways, it’s not that different. The difference is that you are now under the influence of psychedelic drugs at the time, but the actual therapy you’re sitting across from your therapist, you’re discussing your personal problems. The format is similar, but it happens immediately after this drug trip, where you’re no longer feeling the psychedelic effects. Like, funny thing about Ketamine is the it wears off fairly quickly, like after 40 to 60 minutes for me. After that, you just feel kind of a little bit weak in the knees, but otherwise more or less lucid. But you do feel a bit more emotionally vulnerable. In some ways, it kind of breaks down some mental barriers that you might have. It can allow you to access certain memories or emotions or thoughts or feelings that you either were having difficulty accessing before, or even if you weren’t, it might help you consider them in new ways. And when I say it helps you access emotions or memories, like, I’m not talking necessarily about repressed memories that I have forgotten from childhood, it’s nothing like that. But, like, everything pretty much everything that I talked about in these therapy sessions I had talked about in normal therapy before.
Jordan Heath-Rawlings: Okay.
Julian Uzielli: But for whatever reason, when I did it under the influence of this medicine, the therapeutic effect was much greater. It was much more cathartic. And I felt much more as though I was able to actually resolve these issues and to be able to accept things, like accepting the things that I can’t change and just sort of being at peace with things in a way that I wasn’t getting from regular therapy.
Jordan Heath-Rawlings: Do we have any theories on why this happens and why this works?
Julian Uzielli: Yeah. So the main way that Ketamine is thought to work, and like I said, there’s still a lot left to learn, but we know that Ketamine is an NMDA receptor antagonist. So it blocks the NMDA receptor in your brain. What this does is it causes a surge of the neurotransmitter glutamate in your brain. And glutamate is associated with neuroplasticity with sort of forming new connections in your brain. So it’s thought that one of the mechanisms that allows Ketamine to work is that it creates these new neural pathways, like literally expanding your brain. And subjectively, the way that is experienced, at least for me, is that I can think about things from a different perspective. I can think about something that might previously have seemed like a hopeless situation to me. And now I can recognize is out of my control and not worth me dwelling on that kind of thing. That’s one theory. Like I said, there’s kind of two schools of thought. I learned the type that I did at Field Trip, which is Ketamine assisted psychotherapy, which is where you go in with the explicit intention of getting a psychedelic dose of this medication. They want to induce a psychedelic experience and then have therapy after that.
Jordan Heath-Rawlings: Right. And then there’s the other kind where they do not want to induce the psychedelic experience. They give you a much lower dose, actually. And they don’t do therapy. They literally just hook you up to an IV for 40 minutes. And if you want to watch TV, you can do that. If you want to meditate, you can do that. It’s medically supervised, but it’s not involved with therapy. And both of them work based on the evidence, or at least based on the anecdotal reports of their patients. But again, it’s still such a new field that it’s hard to say whether it’s the Ketamine itself that’s causing the change, or whether it’s the combination of the Ketamine and the therapy, or whether it’s the subjective experience of the psychedelic trip that allows these changes to take place. And personally, I think it’s probably some combination of the three.
Jordan Heath-Rawlings: So how widely available and accessible is this kind of treatment? I know we’re both speaking as Torontonians, so, very privileged to have access to some of the most hard to get treatments in the country. But is it growing outside of Toronto? Can you find a clinic in most large cities, like, what are we talking about here?
Julian Uzielli: It is growing, yeah. And so just to give you some context, the clinic that I went to was, according to them, they were the first clinic in Canada to offer ketamine-assisted psychotherapy. And they only opened, like, during the pandemic. So it’s still relatively recent. Since they opened there’s now, I think, like at least two or three other private clinics in Toronto where you can go. And there is one free program at St Mike’s Hospital where they do the non therapeutic kind that I talked about, where it’s just and infusion they’re funded by grants, but there’s a very long waiting list for that. There are now some options and other provinces. In my research, I was able to find similar clinics in Quebec, Alberta, Saskatchewan, BC, and Nova Scotia. So it’s growing. I expect there will be more of them popping up soon, too. And there’s psychedelics are kind of having a moment right now. There’s not just Ketamine, but MDMA is very close to being approved by the FDA in the United States for use in PTSD therapy. Some of those clinical trials are actually happening here in Canada, same with psilocybin mushrooms. A lot of people in the industry think that they are very close to becoming legalized for medical use in a similar context. So-called shroom stocks are a hot thing on the Internet right now if you’re sort of into those communities. So it’s becoming more widely available. And I would not be surprised to see that trend continue in the next few years.
Jordan Heath-Rawlings: In the meantime, a practical question, is this covered by OHIP, or other provincial health organizations, or did you have to pay? And if so, do you mind sharing how much?
Julian Uzielli: Yeah. No, it’s a good question. And it’s not covered by OHIP. As far as I know, it’s not covered by any other provincial health service. It might be covered by some private insurance plans, partially. There’s a lot of caveats in that sentence, right. My insurance I thought I had pretty good insurance, and it didn’t cover any of it. So I had to pay fully out of pocket. I did six ketamine sessions and a few more integration sessions is what they call them, just like regular therapy sessions. And the full cost was $4,700 Canadian.
Jordan Heath-Rawlings: Not cheap.
Julian Uzielli: Which is enormous. I, like a lot of people would never be able to come up with that kind of money. And I feel incredibly fortunate and privileged to be able to have done this and to be able to afford to do this kind of thing. But it leaves me also feeling kind of guilty because there are people that I know and care about who have mental illnesses, and I think could probably really benefit from this and have told me that they’re interested, but they don’t have that kind of money. And what are they supposed to do?
Jordan Heath-Rawlings: And finally, this was a while ago. It sounds like you’re still doing really well. Do we know how long this will last? Is it kind of wait and see if it begins to fade? Keep doing regular check ins.
Julian Uzielli: Yeah. This is one of the other big unknowns about ketamine as an antidepressant, because, as you say, I finished my treatment about six months ago. Now, I have been feeling consistently good since then, and I can actually track this empirically because I have a little mood tracker app that I’ve been using for a couple of years now. And over time, it’ll sort of show your moods on a line graph to show you how you’ve been doing over the course of a few months, or even on different days of the week. If you look at my graph before I did the treatment, it’s like peaks, valleys, peaks, valleys, up, down, up, down. Like my mood was all over the place, and since then, it’s been like a flat line at good. I’ve just been feeling good, which is incredible, but we just don’t have enough research now. And frankly, this hasn’t been used as an antidepressant for long enough for us to know what the long term implications are. We don’t know how long it lasts. We don’t know what the implications are for example, if someone were to do this once a year for the rest of their life, like, would that have any kind of impact on them? We don’t know. Some people find that this works for them for a few weeks or a month, and that then they need to do it again. Others are able to do one session and feel like they’ve had their lives totally changed. And yeah, I feel great. I don’t feel like my mental health has really declined at all. Since finishing, I’ve been able to go back to work. Things are going pretty well for me personally, so I’m hopeful, but yeah, there’s part of me that does worry that maybe my depression will come back because it always has before. But at least this time I feel like I’m much better equipped to deal with it.
Jordan Heath-Rawlings: You’re feeling better, which is awesome. Have people around you, your loved ones, notice a difference?
Julian Uzielli: Absolutely. The biggest difference was probably seen by my wife, Danielle. Obviously, she had a front row seat to the depths of my depression, and it was really hard on her to watch me go through that. And especially during COVID, we’re all feeling isolated, and she didn’t really feel like she had that much support while I was going through that. And now I feel good, and that’s made her life so much easier. She says I’m like a different person, which I feel like a different person. Honestly, my parents, they’ve also definitely noticed a huge change. Similarly, describe it in superlative terms like that. My mom said she was gobsmacked and actually even my therapist, my regular therapist I’ve been seeing for several years, she said she’s never seen this drastic and fast of a transformation in somebody from being so depressed to being just fully functional. And, in fact, I had an appointment with her earlier today, and she said, I don’t think you need me anymore. I think you’re good. And that was a pretty big moment, because I’ve been in therapy for years now. I can’t remember how long it’s been a long time since I’ve had a therapist tell me I didn’t need therapy, so I think that’s a good sign.
Jordan Heath-Rawlings: I’m so glad you’re feeling better. And thank you for sharing this with us today. And it’ll be really interesting to see what we learn about this over the coming years.
Julian Uzielli: Yeah, thanks for having me.
Jordan Heath-Rawlings: That was Julian Uzielli. And that was The Big Story. For more from us, head to thebigstorypodcast.ca, find us on Twitter at @TheBigStoryFPN, and email us anytime, thebigstorypodcast, that’s all one word, @rci.rogers.com [click here!].
Thanks for listening. I’m Jordan Heath Rawlings. We’ll talk tomorrow.
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