Why Norway Matters: Ketamine and the Question of Who Gets to Heal
In August 2025, Norway did something no country had done before. It approved nationwide, publicly funded access to ketamine for treatment-resistant depression. Not a patented variant at hundreds of pounds per dose. The original Ketamine we’ve known and used since the 60’s, available to every Norwegian citizen, free at the point of care.
We think this matters far beyond Scandinavia.
A Drug Hiding in Plain Sight
Ketamine has been in clinical use for over fifty years. It earned its place on the World Health Organisation's list of essential medicines as an anaesthetic. What took much longer to reach patients was something researchers had observed as far back as 2000: at lower doses, ketamine produces a rapid and significant antidepressant effect, often within hours.
For context, conventional antidepressants typically take weeks to months to work, if they work at all. For people with treatment-resistant depression, who have already tried multiple medications without adequate relief, that gap is not an inconvenience. It can be a matter of survival.
The evidence has been accumulating steadily. Multiple meta-analyses, spanning both controlled trials and real-world data, have consistently supported ketamine's rapid antidepressant and anti-suicidal effects. The American Psychiatric Association endorsed it for treatment-resistant depression in 2017. The Canadian Network for Mood and Anxiety Treatments followed. In 2025, the UK's Royal College of Psychiatrists published its own supportive consensus position.
So why has access remained so limited?
The Economics of a Drug No One Owns
Ketamine is generic. There is no patent. No pharmaceutical company has a financial incentive to fund the large, expensive trials that typically drive regulatory approval and reimbursement decisions. The medicine is cheap. The infrastructure to administer it is not. And so, despite a growing body of evidence and institutional endorsement, it remained largely inaccessible within public health systems.
Norway's decision to formally evaluate ketamine through a health technology assessment, and ultimately to reimburse it, represents a different kind of logic. One that asks: does this work, does it help people, and can we afford not to offer it?
The answer, it turned out, was yes on all counts. The Norwegian Medicines Agency concluded that ketamine delivers superior response and remission rates compared with other treatments for treatment-resistant depression, at substantially lower cost.
For additional context, the UK's NICE guidelines on depression offer a useful reference point for how health systems are beginning to weigh these decisions.
What Good Practice Looks Like
The Norwegian model is worth looking at closely, because it is not simply about the drug. The protocol developed at Østfold Hospital, the first dedicated public ketamine unit in Scandinavia, integrates preparation, music, eyeshades, and concurrent psychotherapy as a mandatory part of treatment. It recognises that the subjective experience of ketamine is not a side effect to be managed. It may be part of how the medicine works.
This is the direction the field is moving. Emerging data suggests that pairing ketamine with psychotherapy may extend and deepen the therapeutic benefit. The mechanism is still being studied. But the hypothesis is compelling: ketamine appears to open a window of neuroplasticity, a period in which the brain is more receptive to change. What happens in that window, and what support surrounds it, may matter enormously.
This integrated approach, combining the biomedical and psychotherapeutic, closely mirrors what researchers have described as the Montreal model for ketamine in severe treatment-resistant depression.
Where We Are
At Mirabilis Health, we launched Northern Ireland's first ketamine-assisted psychotherapy programme in February 2026. We did not arrive at this lightly. Professor Paul Miller's clinical and psychiatric oversight, our integration of psychotherapy within the treatment model, and our position as a clinical research site all inform how we approach this work.
We are not offering a cure. We are not certain of everything. We are researchers and clinicians who believe the evidence is strong enough to act on, and that people in our communities deserve access to what the science is pointing toward.
Norway has shown that a public health system can make that same call. We hope others follow.
If you are a clinician, a researcher, or someone who has been struggling with depression that has not responded to conventional treatment, we would welcome a conversation.