Opinion: Esketamine and psychedelics will require restructuring mental health care visits

Mary’s depression roared back with a vengeance: three visits in three weeks to the emergency department of a busy inner-city hospital in downtown Toronto. The third time she was actively suicidal, and was whisked away to the psychiatric crisis unit on the bright and airy fifth floor.

I was a medical student at the time, doing a rotation in psychiatry, and was given the task of spending time each day with Mary (I’m using a pseudonym here) to monitor her symptoms, her insight into her illness, and the goals of her care. Nothing the medical team tried seemed to work. She was on the maximum dose of her antidepressant, a selective serotonin reuptake inhibitor (SSRI). An experimental trial of deep-brain stimulation months earlier had little effect. By definition, our 52-year-old patient met