“There was a time when all those who are dead passed. They fly by, I try to stop them and they go away.” In the video, Ihor speaks, a Ukrainian soldier who in April 2022 survived the siege of the Azovstal steel plant in Mariupol, and was then captured and tortured by the Russian army.
Ihor is under the effects of ketamine, an anesthetic that is also used as a recreational drug and that over the last five years has revolutionized treatments for severe depression. He is cared for by Vladislav Matrenitsky, a former doctor specializing in physiology and molecular biology who switched to psychiatry two decades ago.
Matrenitsky runs the only clinic in all of Ukraine that carries out this type of therapy and defends its potential, as well as that of other psychedelics such as MDMA and psilocybin, in the face of the mental health epidemic in soldiers and civilians that anticipates the war in the country.
“80% of soldiers will have mental health problems,” he says. “There will be a great need for assistance with these types of disorders.”
Located in the north of kyiv, his clinic has already treated hundreds of army veterans and also civilians with trauma derived from the conflict. The session lasts about 40 minutes and costs, in exchange, about 100 euros, although the center offers some free treatments for soldiers.
For some psychiatrists, ketamine-assisted therapy represents the main relevant medical innovation against depression in almost 50 years. More than 80 studies have already been published that demonstrate its positive effects in cases of severe depression, although there is still not enough medical evidence regarding other pathologies such as post-traumatic stress.
“Of course, ketamine is not a panacea and it does not help everyone,” the therapist clarifies, “but in general terms I would tell you that it is 50% more effective than traditional treatments.”
Eduard Vieta, head of Psychiatry at the Hospital Clínic of Barcelona, pointed out a couple of years ago that the treatment had managed to cure patients with many years of severe depression behind them. “It has been very shocking,” he summarized.
Matrenitsky, who opened his clinic in 2018 when the Government gave permission to use this anesthetic, is now dedicated to collecting data that supports the use of the substance for both depression and other mental illnesses. His intention is for Zelensky’s Executive to also allow treatment with other psychedelics that are not permitted today.
“The objective is that ketamine treatment can be extended to all state hospitals,” he explained during a break at the Barcelona congress. “Currently the Government has created a committee to consider the possibilities and we hope in a year to have permits to do clinical studies with other psychedelics and perhaps also use them.”
Preliminary sessions and assisted therapies
At Matrenitsky’s clinic, psychologists usually conduct one or two preliminary sessions with potential patients to determine if they can undergo treatment and to verify that more conventional therapies have not worked. After this first filter, two weekly sessions are carried out in which the substance is injected with a syringe. Treatment can last between six and 12 weeks.
Matrenitsky sees ketamine therapy as an effective gateway to the subconscious from which trauma can be addressed: the noises of detonations, explosions, images of corpses recorded in the subconscious. “When you see what is happening on the front, your psyche becomes vulnerable,” he explains.
During the sessions, the psychologists ask the patient questions about what they see, the smells and textures they feel, the images they remember… And they guide the session to try to “release” the soldiers’ traumas.
The treatment is also not free of the stigma that this type of therapy still has. “Part of the population still does not understand the difference between taking drugs and carrying out these treatments, although in the last year we have seen some change,” says the therapist. “The majority of our patients are educated and well-informed citizens, the intention is that prejudices will be diluted among all citizens.”
Nor is there a great culture of opening up to a therapist in the country, whose Soviet heritage still survives. “Little by little, people are understanding the need to address their traumas,” he notes. “The problem is that many of the therapists do not have experience when it comes to dealing with soldiers.”
Matrenitsky also sees ketamine therapy as a way to prevent alcohol and other substance abuse in war-traumatized soldiers. “Many soldiers abuse drugs because they can’t find any other way to lessen their inner pain,” he maintains. “That is why it is relevant that they can look for ways to heal and avoid the abuse of alcohol and other substances.”
Could these patients end up hooked on ketamine? Matrenitsky believes no and remembers that the substance does not cause addiction if it is consumed a dozen times sporadically.
One of his patients, however, pointed out in a documentary that the therapy had cured his depression but he realized that he wanted to continue taking the anesthetic. “I noticed that I wanted more and that was the sign that this can capture you,” he said.
During the conversation, the therapist insists on several occasions about the epidemic of mental disorders that will come the day the war ends. “Psychological wounds cost more to heal than physical wounds and they usually appear after a while,” he argues. “The wounds will last a long time and treatment with psychedelics can help them heal faster.”
DM
