Norway Becomes the First Country to Publicly Fund Generic Ketamine for Depression

By Lowan Han Stewart, MD

In the year 2000, psychiatry experienced one of the most important breakthroughs in decades: researchers showed that ketamine, a widely used anesthetic, could produce a powerful antidepressant effect within hours. For patients suffering from severe depression, this was something radically new. Traditional antidepressants take weeks or months to work, and many patients never respond at all. Ketamine was capable of relieving depressive symptoms in the majority of these patients rapidly—even when they did not respond to several conventional antidepressants.

Despite excitement in the field, access to ketamine treatment remained limited for years. Ketamine was already considered an old generic medication. Off-patent and inexpensive, there was little financial incentive for pharmaceutical companies to fund the massive regulatory trials required for approval and reimbursement. As a result, ketamine treatment developed slowly, often outside mainstream public healthcare systems.

In most countries today, ketamine treatment for depression remains difficult to access. It is frequently only available in private clinics, often expensive, inconsistently regulated, and rarely reimbursed through public health systems or private insurance.

This changed in August 2025, when Norway became the first country in the world to approve nationwide public reimbursement for off-label racemic ketamine for treatment-resistant depression.

From Anesthetic to Psychiatric Treatment

Ketamine was synthesized in 1962 and approved for anesthesia in the United States in 1970. At lower, subanesthetic doses, ketamine produces profound alterations in consciousness. Patients experience changes in perception, emotions, body awareness, and sense of self. This feeling of distance from the body and self led to its initial classification as a “dissociative anesthetic.”

The psychotherapeutic potential of ketamine was recognized long before modern antidepressant studies. During the 1970s and 1980s, psychiatrists in Iran and the former Soviet Union experimented with ketamine-assisted psychotherapy, using the altered state itself as a catalyst for psychological change.

Meanwhile, a different research pathway was emerging in the United States, as researchers began investigating glutamate and NMDA receptor mechanisms in depression. In the year 2000, a landmark randomized controlled trial demonstrated that ketamine could dramatically reduce depressive symptoms within hours.

Over the following two decades, study after study confirmed ketamine’s rapid antidepressant and anti-suicidal effects. Numerous meta-analyses have since supported these findings. Ketamine appears to work through multiple overlapping mechanisms, including enhanced neuroplasticity, modulation of dysfunctional neural networks, anti-inflammatory effects, and additional psychological mechanisms enhancing cognitive and behavioral change.

Many questions remain unanswered. Researchers are still trying to determine the best maintenance strategies, the durability of benefit, and how psychotherapy might enhance long-term outcomes.

The Norwegian Approach

Norway entered the ketamine field relatively late compared to the United States. Initial efforts to introduce ketamine into the Norwegian public healthcare system moved slowly, and private clinics began offering treatment in Oslo in 2018. This sparked debate within Norwegian psychiatry, but the Norwegian Medical Board concluded in 2019 that ketamine treatment for treatment-resistant depression constituted professionally sound off-label practice based on the current available evidence.

That same year, Johnson & Johnson’s patented esketamine nasal spray, Spravato, received European approval for treatment-resistant depression. Despite regulatory approval, the drug was extremely expensive, costing more than one hundred times as much as generic racemic ketamine per effective dose. Norwegian health-economic assessments concluded that the cost-benefit profile was unfavorable, and instead of adopting the patented alternative, Norway gradually invested in public treatment infrastructure using the generic ketamine.

One of the most important developments in Norway was not simply the creation of isolated units, but the development of a coordinated national infrastructure. In 2020, Scandinavia’s first dedicated public ketamine unit for depression and acute suicidality opened at Østfold Hospital. Protocols developed at Østfold Hospital were openly shared with other hospitals, allowing rapid implementation across the country. New ketamine units were subsequently established in every major hospital in all health regions.

The Norwegian public model differs from many international ketamine programs in important ways, and is most similar to that used in Canada known as the Montreal model. Patients receive a structured induction series followed by maintenance treatment, but the protocol also incorporates psychotherapeutic and environmental components often associated with psychedelic therapy: preparation sessions, music, eyeshades, and mandatory concurrent psychotherapy. This integrated approach reflects the growing belief that ketamine’s effects may involve more than simple pharmacology. The altered state itself may create opportunities for emotional processing, psychological flexibility and cognitive and behavioral change. Norway chose to incorporate psychotherapy into the treatment from the outset.

In 2023, the Norwegian Rapid Acting Antidepressant Network (NORAAD) was created to coordinate national research and clinical development. The network brought together psychiatrists from all Norwegian health regions and helped organize Norway’s first national meeting on ketamine in psychiatry. NORAAD also secured public funding for a large multisite randomized controlled trial involving eleven psychiatric units across Norway. Preparing for the trial required all the hospitals to develop the physical infrastructure, training systems, and personnel necessary not only for research, but for routine clinical implementation as well.

This may prove to be one of the most important aspects of the Norwegian model. Interventional psychiatric treatments require not only efficacy, but also implementation and accessibility. Ketamine treatment involves monitoring, interdisciplinary collaboration, and specialized training that goes beyond simply prescribing a pill. Norway invested in building the system itself.

The 2025 Decision

The decisive breakthrough came in 2025. After a formal health technology assessment, the Norwegian Medicines Agency concluded that ketamine for treatment-resistant depression was well tolerated, effective, and substantially more cost-effective than the gold-standard comparator of electroshock therapy.

In August 2025, Norway officially approved nationwide public reimbursement for off-label racemic ketamine for treatment-resistant depression. For the first time anywhere in the world, all patients meeting criteria within a national healthcare system could access ketamine treatment without personal financial burden.

Importantly, Norway paired reimbursement with mandatory data collection through registries and clinical studies. This creates an unprecedented opportunity to gather long-term real-world data from potentially thousands of patients treated within a coordinated public health system.

A Different Model for Psychiatry

The Norwegian ketamine model stands in sharp contrast to the fragmented, heavily privatized landscape that has emerged elsewhere. It demonstrates that innovative psychiatric treatments do not necessarily need to be extraordinarily expensive. Ketamine is cheap. The costs lie in personnel, infrastructure, monitoring, and psychotherapy, which are existing components of public health care systems.

At a time when many new psychiatric medications and interventions cost tens to hundreds of thousands of dollars annually, ketamine represents something unusual: an effective and relatively affordable treatment emerging from the repurposing of an old generic medicine.

Norway’s decision also reflects a broader principle: that public healthcare systems can prioritize health equity and value-based care over strict dependence on traditional pharmaceutical industry pathways. In March of 2026, France became the second country in the world to reimburse generic ketamine treatment for a psychiatric indication - for the treatment of suicidal crisis, under a compassionate use program.

Whether other countries follow remains uncertain. But Norway has now created a real-world national experiment in publicly funded rapid-acting antidepressant treatment. We expect it to become an important modern example of how psychiatric innovations such as the other psychedelic medications on the horizon can be implemented at scale—not only effectively, but affordably and equitably.

To access the full publication from the Drug Science Policy and Law journal, please see below:

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Dr. Lowan Han Stewart is a specialist in emergency medicine, Expert Faculty Member of the American Society of Ketamine Physicians, Medical Director at Axon Clinic, and Medical advisor, PsykForsk Center for Innovative Clinical Research, Østfold Hospital Trust