Frequently Asked Questions
A referral can be made by your healthcare provider at our referral page. Staff at the CRTCE will conduct a comprehensive assessment of your psychiatric history, medical history and family history. Moreover, a full list of all previous treatments taken will need to be determined to ensure you have a treatment resistant disorder. Once you have been determined to be eligible for ketamine therapy, an appointment time will be scheduled for you at the Canadian Rapid Treatment Center of Excellence (CRTCE).
Ketamine is delivered through intravenous infusion. A physician, who is trained in anesthesia, as well as a nurse, will oversee the infusion of the treatment.
Ketamine is a pharmaceutical that was originally developed for the purpose of assisting in anesthesia. It is referred to as a dissociative anesthetic. The term dissociative anesthetic has more than one definition. One of the most commonly referred to definitions for a dissociative anesthetic is an agent that can cause dissociative symptoms, which loosely means that “reality can be somewhat blurred”. In other words, images may appear unreal or slightly distorted and/or create other perceptual disturbances.
The lead physician is Dr. Roger S McIntyre, Professor of Psychiatry and Pharmacology at the University of Toronto, Head of the Mood Disorder Psychopharmacology Unit University Health Network, Chairman and Executive Director Brain and Cognition Discovery Foundation, and President of the Canadian Rapid Treatment Center of Excellence.
The mechanism of how ketamine alleviates depressive symptoms is not known. It is generally agreed that there are multiple mechanisms that likely contribute to ketamine’s ability to relieve depressive symptoms. It is hypothesized that these mechanisms include, but are not limited to, targeting glutamate, dopamine, serotonin, opiates, as well as molecules in the brain responsible for brain cell growth and development.
Based on the available evidence, individuals receiving ketamine begin to report relief of depression within one day of administration of the first infusion. Others may take longer but the overall majority of people who are going to benefit from ketamine benefit within 1-2 weeks.
Yes. The Canadian Rapid Treatment Centre of Excellence has been inspected and approved by the College of Physicians and Surgeons in Ontario. The CRTCE is mandated to maintain its professional practice in accordance with the standards of care that are listed on the CPSOs website for Out-of-Hospital Premises Inspection Program, OHPIP, Program standards (Guidelines and Standards PDF).
Any one of your doctors may be able to submit a referral for an assessment to our clinic. To submit a referral, your doctor can visit www.crtce.com/refer-a-patient
Intravenous ketamine is a drug that has abuse liability. That being said, the doses of ketamine that are being used for the treatment of mood disorders are a relatively small dose. Moreover, there is no evidence those individuals receiving ketamine for treatment resistant mood disorders in carefully supervised and specialized centers are at risk of abusing ketamine and other substances, as a consequence of ketamine treatment (e.g. opiates).
The protocol for administering ketamine is still being refined. Nonetheless, at this point in time, most individuals will receive 4 infusions (i.e. 4 infusions within a 7-10 day span). These 4 infusions represent an acute treatment trial.
Your referral will be assessed by the treatment team at the CRTCE within 2-3 business days. Subsequent to that, if eligible, an appointment for an initial assessment will be made for you within 2-6 weeks.
Ketamine is offered at the CRTCE as an intravenous infusion. The CRTCE will also be evaluating ketamine through intranasal delivery. Indeed ketamine is available through other routes (e.g. oral, but this is not offered at the CRTCE).
Ketamine differs from other anti-depressants in many ways. What’s most apparent about ketamine, as a different treatment, is that it begins to demonstrate efficacy within 1-2 days. Most anti-depressants require 2-4 weeks before they begin to show significant improvement in symptoms.
Based on the available evidence, individuals receiving ketamine begin to report relief of depression within one day of administration of the first infusion. Others may take longer but overall the majority of people who are going to benefit from ketamine benefit from 1-2 weeks.
The Canadian Rapid Treatment Center of Excellence will be serving treatments Monday to Saturday, mornings, afternoons and evenings.
No. Your initial assessment at the CRTCE would be covered by OHIP. The overarching aim of your referral of the initial assessment is to clarify and confirm what your diagnosis is to determine the appropriateness of your current and past treatments, as well as to consider appropriate treatment avenues for you. It is fully expected that many individuals may not be considered appropriate candidates for ketamine and/or will be recommended alternative treatments to ketamine.
The age eligibility for ketamine at the Canadian Rapid Treatment Center of Excellent is 18-65 years of age.
The long-term efficacies of ketamine in individuals who have responded to this treatment modality are not yet fully known. Emerging evidence indicates that some individuals remains well for several months. Undoubtedly, there will be some individuals who remain well for longer periods of time. It’s also known that other individuals will require booster sessions to maintain their feelings of wellness. The booster sessions are typically administered approximately once per month.
Generally speaking, the dose of ketamine administered is 0.5mg/kg. This dose results in a blood concentration of ketamine of about 10%-20% of what is usually used in anesthesia.
Yes. The Canadian Rapid Treatment Center of Excellence is associated with the Mood Disorder Psychopharmacology Unit, one of the world’s leading centers for identifying causes and cures of mood disorders. There are many research protocols that will be conducted in addition to offering ketamine treatment for mood disorders.
You’ll be asked to not eat or drink during the infusion and approximately 6-8 hours before the treatment.
Ketamine has been used for many years in anesthesia and other medical conditions (e.g. pain disorders). The U.S. FDA approved ketamine in 1970 as an agent for anesthesia. During the last two decades, a growing body of evidence supports its use in treatment resistant mood disorders. When ketamine is administered at a center where the personnel are experts in the delivery of ketamine and where that center has appropriate safety monitoring and surveillance of patients, ketamine appears to be safe and generally well-tolerated. As ketamine has not been studied in mood disorders for longer periods of time (i.e. a year or longer), its long-term safety remains to be established, and it is currently a focus of research.
Available evidence indicates that ketamine may reduce thoughts of suicide in individuals who are suffering from mood disorders. It remains an open question whether ketamine reduces attempts of suicide or whether it reduces the overall suicide rate.
The most common side effects of ketamine are dissociation, which is when images appear somewhat distorted. Dissociation can affect up to a third of people during the first infusion. The overall number of people who experience dissociation decreases with each subsequent infusion. It is also noted that some people may have an increase in blood pressure or heart rate during infusion therapy. That will be monitored closely during by your health care team. Although it is rare, some people may experience changes in liver or kidney function, and/or notice blood in their urine. These are considered rare events and more typically associated with much higher doses of ketamine for longer periods of time and/or people who abuse ketamine.
Ketamine is a drug that has abuse liability. That being said, the doses of ketamine that are being used for the treatment of mood disorders is a relatively small dose. Moreover, there is no evidence those individuals receiving ketamine for treatment resistant mood disorders in carefully supervised and specialized centers are at risk of abusing ketamine and other substances as a consequence of ketamine treatment e.g. opiates.
You’ll be provided with the phone number and contact information of the medical staff at the CRTCE. You’ll be able to call them to discuss any side effects or safety concerns. The contact will be available during business hours. After hours, you’ll be encouraged to go to your local emergency room.
The cost of an acute treatment trial (i.e. 4 infusions in two weeks) is $3000. This price includes the harmonized sales tax (HST). This fee represents the cost of professional services and the administration of this treatment. All individuals will need to pay the full cost of an acute treatment trial prior to having a first infusion schedule.
No. You’ll need to be accompanied on your way home following the infusion of ketamine treatment.
Drugs that may interfere with ketamine treatments may be determined by your health care team at the CRTCE during assessment.
Individuals who are abusing ketamine and/or other illicit substances would not be candidates for ketamine treatment. At this point in time, ketamine has not been studied for individuals who have psychotic symptoms (e.g. delusions and hallucinations), and as such, that would also be a contraindication. Any person who has unstable cardiovascular disease, renal or liver diseases, or for that matter any other unstable medical disorder would not be eligible for ketamine treatment. Every person’s eligibility and contraindications will be discussed on a case-by-case basis on during the initial intake.
You’ll need to speak to your insurance company regarding the matter. These decisions are made on a case by case basis, as the use of ketamine in treating mood disorders is relatively new avenue of care.