The only thing Evelyn Larson was able to do at the height of her depression was to take her dog Grizzly on his daily walk in Haines Junction, Yukon.
Larson suffers from treatment resistant depression. Her symptoms are so severe that it causes physical pain for her to go about her daily life.
"Seven months, I was in crisis," Larsen told CBC News. "Waking up at 4:30 in the morning with 10,000 TVs in your head saying you're better off dead."
Larson and her team of doctors cycled through 11 different antidepressants in that period to alleviate her symptoms. None worked.
By March, Larson and her psychiatrist decided to try ketamine treatments. So she wrote Larson a referral to the Linden Centre, a private ketamine clinic, in Saskatoon.
Ketamine is offered in several forms. Esketamine nasal spray, offered twice weekly for two months and then once a month for a year, is Health-Canada approved as a treatment for depression. Other forms, like IV drips, are not.
Larson and her team picked IV treatments because the shorter three-week treatment period meant Larson could come back to the territory to work.
The IV treatments, at a total cost of $3,500, are also less expensive than the nasal spray, which would cost roughly $7,200 at the Linden Centre.
Their request to Yukon Insured Health Services was refused twice. The first time, because the Yukon's Health Department said it doesn't cover treatments in private clinics. The second time, they heard back directly from Tracy-Anne McPhee, the territory's health minister.
That letter, dated July 21, said they would not fund Larson's IV ketamine treatments because they are not approved by Health Canada.
In an Aug. 11 response to a CBC media request, the department says it does cover the cost of nasal spray esketamine because it's Health Canada-approved.
Had it been approved by the government, I would have felt worthy of receiving medical care, that I deserved it. - Evelyn Larson, ketamine patient from Haines Junction, YT
Except Larsen said that wasn't communicated to her healthcare team.
That left Larsen and her family paying just over $7,000 for IV ketamine treatments, flights and accommodations out of their own pockets — something she said they can't afford.
On top of the financial hit, Larsen said she felt further betrayed by the government's seeming indifference to her plight.
She would have considered taking nasal spray treatments, Larson continued, despite the major life disruptions it would cause, out of desperation.
"Had it been approved by the government … I would have felt worthy of receiving medical care, that I deserved it," Larsen said.
'There's not a lot of systemic oversight'
Yuliya Knyahnytska, a staff psychiatrist at the Centre for Addiction and Mental Health in Toronto, said private health clinics started using esketamine for treatment-resistant depression at least a decade ago.
In 2020, Health Canada approved its use for major depressive disorder, at the height of the COVID-19 pandemic.
Roger McIntyre, professor of psychiatry and pharmacology at the University of Toronto, said the type of ketamine used in IV drips is already approved by Health Canada as an anesthetic, but is being used "off-label" for treating depression.
McIntyre said this is normal in clinical practice if the potential benefits outweigh the risks.
"The evidence is showing that it's safe and effective in the short term," McIntyre said.
"But I understand the position … that [the Yukon government] is going to cover what's approved."
Knyahnytska said it could be challenging for provincial or territorial governments to justify covering IV treatments under public healthcare plans unless Health Canada gives it a formal stamp of approval for this new use.
That means patient access to the appropriate type of ketamine treatment, she continued, is still very hard to get.
"There's not a lot of systematic oversight from government or other regulatory bodies in how ketamine is administered by who, when and for which population," Knyahnytska said.
Still, McIntyre said insurance coverage for ketamine isn't unheard of. Some public sector employees, like those in the Canadian Armed Forces and RCMP, are able to access fully-funded ketamine treatments, including both nasal and IV forms, under their workplace insurance plans.
If we have a medical solution to a medical problem, I dont think any Canadian wants finances to be a barrier. - Dr. Roger McIntyre, professor of psychiatry and pharmacology at the University of Toronto
McIntyre's next hope is for governments across Canada to make all forms of ketamine available for patients with depression, despite the Health Canada roadblocks, so they can receive the right standard of care.
"If we have a [medical] solution to a medical problem, I don't think any Canadian wants finances to be a barrier," McIntyre said.
An emailed statement from Health Canada says it does not offer treatment recommendations or guidelines for how medical professionals administer the drugs they authorize and regulate.
The provinces and territories regulate how and when medical professionals can use a medication as "off-label" to treat other conditions than the ones Health Canada has approved, the statement continues.
'There was just no hope at all'
Larson said she didn't have enough money on her own to pay for the treatments. When the referrals started, she was on 15-week federal medical employment insurance and, later, on social assistance.
Her older sister Jo-Anna Wohlgemuth stepped in, starting a Go Fund Me campaign.
"I just felt it was very important," Wohlgemuth said from her home in Camrose, Alta.
"She honestly didn't want to die … but there was just no hope at all, and this treatment was one way of getting her that hope."
Friends, families, even strangers contributed as much as they could, raising $6,525 — enough for the treatments, airfare and accommodations but not for general expenses like groceries.
It left Larson with a $1,083 difference that she increased her credit card limit to cover.
Things are looking up, Larson said, now that she's done the treatments.
She started a new job, picked up hobbies like hiking again and is connecting more regularly with friends.
Larson hopes the treatments will last six months. At that point, she'll have to go back to Saskatoon for two more boosters.
Both Larson and Wohlgemuth hope the Yukon government will, by then, consider extending their coverage to the IV treatments she needs.