On the phone, Nancy Lapointe's voice breaks as she remembers what she whispered to the nurse who was preparing her for electric shocks for the umpteenth time: “Can you please make a medical mistake and just let me go?” »
Posted at 5:00 am
For five years, the blonde Terrebonne resident had tried everything to eliminate depression. One drug after another, electric shock, in vain.1
“I was diagnosed with incurable cancer so that medical assistance in dying (MAiD) would be possible for people with psychiatric disorders like me…”
Unless there is a turnaround in Ottawa, Nancy Lapointe's second wish will come true on March 17. Canadians suffering intolerable and persistent mental suffering will then be eligible for MAID. As has been the case for several years with people with similar physical complaints and people at the end of their lives.
However, three years ago, Ms. Lapointe stopped planning her disappearance. In 2020, a dissociation-causing anesthetic – ketamine – dissolved his suicidal thoughts in a flash in a small room at the University of Montreal Hospital Center (CHUM).
Almost suddenly, after two infusions, I wanted to be reunited with my daughters! It blew me away because even seeing the people I love again didn't bring me joy for years.
To avoid a relapse, Nancy Lapointe had to take numerous doses of ketamine for a year. It was time to undergo a rare surgery that would more permanently improve the function of his brain through an implant implanted near a nerve.
Today the former respiratory therapist is working in a new area. She was nevertheless declared incapacitated for life.
“Ephemeral but extraordinary”
In recent years, a growing number of Quebecers have managed to emerge from despair – at least temporarily – thanks to cutting-edge or experimental interventions. Ketamine, neuromodulation with or without implant, hallucinogenic substances…
It is imperative that doctors have “up-to-date and reliable data on all potential treatments” before they are faced with new requests for medical assistance in dying, two psychiatrists argue in a case study published last fall.2
In less than two weeks, a cocktail of ketamine and intensive psychotherapy ended 15 years of persistent suicidal thoughts in a patient at the Jewish General Hospital in Montreal, explains the article by doctors Nicolas Garel and Kyle Greenway. After requesting medical assistance in dying twice, the sexagenarian withdrew her request and moved closer to her son and grandchildren.
Declaring a disease incurable without seriously considering all options could have serious and irreversible consequences.
Psychiatrists Nicolas Garel and Kyle Greenway
“Ketamine is not a miraculous intervention that everyone will respond to, but for some patients it will be,” adds Dr. Nicolas Garel added in an interview.
The challenge is maintaining the magic, he warns. “Otherwise, the antidepressant effect only lasts a few days, after which most people suffer a relapse. »
PHOTO PROVIDED BY DR. NICOLAS GAREL
Dr. Nicolas Garel, psychiatrist at CHUM, photographed at Stanford University School of Medicine, where he is completing postdoctoral training in addiction prevention and treatment until next June
Constant administration of ketamine is unthinkable. This would be too burdensome for the network and potentially too risky as this substance can be addictive and then cause bladder damage and cognitive impairment. The star of the TV series Friends Matthew Perry drowned after taking it.
With a safer and more comprehensive approach, 30% of people suffering from hyperrefractory depression treated with ketamine can return to work or live a life worthy of the name, says Dr. Kyle Greenway, who developed this formula at the Hospital Jewish General along with Dr. Garel.
PHOTO MARCO CAMPANOZZI, THE PRESS
Every week at the Jewish General Hospital in Montreal, psychiatrist Kyle Greenway treats up to six patients with ketamine. “We need to focus on the patients whose conditions are most serious,” he says. They often have not responded to electroconvulsive therapy, have already taken 20 medications, have already been to the hospital, participated in day programs, etc. »
“It's huge! he said. Regardless of treatment, such remarkable benefits are typically expected in only 2% or 3% of these patient types. »
Dr. Paul Lspérance, who treated Nancy Lapointe at CHUM, shares this enthusiasm. “In 25 years of practice, I have never seen anything that works like ketamine. The effect is fleeting, but it is extraordinary to watch! It allows certain people to escape a vicious circle in which they slept, stayed at home, isolated themselves, wanted nothing and therefore no longer had a source of self-esteem. »
In general, Dr. Lspérance firstly uses transcranial magnetic stimulation, which reactivates or calms the brain without electrical shocks by supplying it with electricity. With the help of his nurses, the program he leads has grown and created new programs in the region.
PHOTO ALAIN ROBERGE, THE PRESS
The psychiatrist Paul Lspérance in one of the two small transcranial stimulation rooms at the CHUM, where he carries out treatments with nurses who also pre-examine the patients.
Unfortunately, the patient and the healthcare system end up with a somewhat defeatist perspective when, no matter what treatment, nothing works. Because of this phenomenon of therapeutic inertia, many people with chronic depression are not offered advanced interventions.
Dr. Paul Lesperance, psychiatrist
Life must have meaning
What should we do when a patient is offered a promising treatment but insists that he be helped to die instead?
Unless he already has a long period of care, his condition cannot be considered incurable, which is required by law. “If there is a rejection, we explain to the person why they still have a chance of recovery and let life go on without forcing anything,” explains Dr. Mona Gupta, psychiatrist at CHUM and former president of the Expert Group on MAID and Mental Illnesses. Often the person reconsiders their decision on their own, sometimes encouraged by their family. »
Even after decades of treatment failure, making a decision can remain difficult because doctors fear that severe depression could cause excessive dark thoughts that cloud judgment.
Researchers in Toronto came up with the idea of using ketamine to make these thoughts disappear to see if the desire for MAID disappeared at the same time.3
Bioethicist Marie-Alexandra Gagné has nothing against such a “test” as long as it does not serve as a shortcut and does not become a prerequisite for MAID.
We cannot force people to adopt interventions that they believe contradict their values or are intolerable. Especially when we don’t yet know the long-term risks.
Marie-Alexandra Gagné, PhD student in bioethics and lecturer at the University of Montreal
It doesn't matter whether a patient suffers from cancer or depression, respect for their boundaries and decision-making autonomy is essential, says Ms. Gagné, who also works as a clinical and organizational ethics consultant in the health network.
“Some people have tried almost every treatment over the years. They are exhausted, no longer believe in it, and we cannot force them to try all the experimental therapies or continue to live with their suffering in the hope that science will – maybe – find a cure in 10 years… »
“Sometimes dying really meets the needs and values of the person who requests it because they can no longer engage in the activities that gave their life meaning. »
1. TheThe electroconvulsive therapy caused M. excessive memory lossMe Lapointe, but this last resort is effective in about half of patients.
Will we have the resources?
Like chemotherapy, ketamine infusions are given slowly and under supervision. In some services, a psychiatrist also provides psychological support before and after sessions, sometimes even during the session. The bill adds up quickly, but inaction can prove even more costly, points out Dr. Kyle Greenway of Jewish General Hospital. “Patients treated with our approach were hospitalized for several months previously and that is no longer the case. » Since each night in the hospital costs $2,000, each similar recovery can mean hundreds of thousands of dollars in savings, he says. Opponents of medical assistance in dying (MAID) continue to fear that desperate people will resort to this last option due to a lack of sufficient care. A scenario that Dr. Mona Gupta from CHUM believes it is unlikely: “Access should be better, especially on the front line. But the patients suffering most are in a different situation, as they are at the top of the list for innovative and promising treatments. » The Ministry of Health and Social Affairs has written to us about the current use of these approaches that “it is critical that physicians inform their patients about the options available, but are explicit about the limitations and framework within which these treatments can be offered.” He adds, “Recognize the importance of continued research into new treatments ” and “rely on the National Institute of Excellence in Health and Social Services to review their current use or on the public network.”
Have you received ketamine-based treatments through a health network or privately? We would like to know what impact they have, whether positive or negative. Write to us absolutely confidentially.
DO YOU NEED HELP ?
- Quebec Suicide Prevention Telephone: 1866 APPELLES (277-3553)
- ParentLine: (1 800 361-5085)
- Tel Youth: (1 800 263-2266)