Welcome to Forbes MediClinic, where hope and healing converge in the realm of mental health. As a pioneering ​ketamine infusion therapy clinic located in Moncton NB, we are dedicated to transforming lives of Maritimers who ​are impacted by treatment-resistant depression and PTSD.

At Forbes MediClinic, our mission is rooted in compassion and cutting-edge care. We understand the profound ​challenges that individuals facing mental health issues encounter, and we stand at the forefront of a revolutionary ​approach – ketamine infusion therapy. This innovative treatment has shown remarkable efficacy in providing relief ​to those who have struggled with traditional therapies.

Our team of experienced medical professionals is committed to personalized care, ensuring that each patient ​receives the attention and support they deserve. We strive to create a welcoming and serene environment where ​healing can flourish. Through a multidisciplinary approach and a focus on individualized treatment plans, Forbes ​MediClinic aims to be a beacon of hope for those seeking transformative solutions in their mental health journey.

Explore the possibilities of a brighter future with Forbes MediClinic, where breakthroughs happen, and a path to ​renewed well-being begins. Your journey to healing starts here.

Ketamine INfusion therapy

Ketamine is a dissociative anesthetic that has been used for decades in the administration of general anesthesia. ​Recently, ketamine has been accepted and utilized as an effective and safe treatment for depression and post-traumatic ​stress disorder (PTSD) .

Numerous clinical trials have validated ketamine as having rapid and robust antidepressant effects in individuals who ​continue to experience symptoms of depression and PTSD despite utilizing traditional treatment regimens. Ongoing ​research into the efficacy of using ketamine to treat mental health conditions points towards ketamine's unique ​mechanism of action which involves influencing the glutamate system in the brain, specifically the N-methyl-D-​aspartate (NMDA) receptors. This interaction triggers a cascade of neurobiological processes, including the release of ​neurotransmitters and the formation of new neural connections. These effects are thought to contribute to the rapid ​and profound antidepressant and anti-anxiety effects observed with ketamine therapy.

In fact, one of the distinguishing features of ketamine therapy is its ability to induce rapid relief, often within hours or ​days, in contrast to traditional antidepressants that may take weeks to show effects. This quick onset can be crucial for ​individuals facing severe and persistent symptoms.

Despite the increasing evidence for the use of ketamine in the treatment of mental health conditions, its approval by ​Health Canada for these purposes is still pending.

Our Treatment Process

Patients undergoing ketamine infusion therapy experience a carefully monitored and controlled treatment session. A ​typical treatment protocol involves a series of infusions administered over several weeks. During each infusion, a precise ​dosage of ketamine is administered intravenously. The duration of each infusion varies but generally lasts around 40 ​minutes, and is followed by a 20 minute observation period.Our treatments are delivered and monitored by Dr. Stewart ​Forbes, a fully licensed anesthesiologist who is a fellow of the Royal College of Physicians and Surgeons of Canada.

Individualized Treatment Plans

At Forbes MediClinic, we prioritize individualized patient care. Each patient undergoes a thorough assessment to ​determine the most suitable treatment plan. Factors such as medical history, current medications, and the severity of ​symptoms are carefully considered to tailor the therapy to the unique needs of the individual. While ketamine infusion ​therapy has demonstrated efficacy, it is essential to approach it with a comprehensive understanding of potential risks ​and benefits. Our medical professionals at Forbes MediClinic prioritize safety, adhering to established and emerging ​protocols and guidelines to ensure the well-being of our patients.

the Referral process

As part of our commitment to providing comprehensive and coordinated care, Forbes MediClinic has a direct referral ​policy for our ketamine infusion services. This means that Forbes MediClinic will only accept referrals directly from a ​patient's primary mental health care provider.

This policy is rooted in our dedication to ensuring the highest standard of care for our patients. By streamlining the referral ​process through primary mental health care providers, we aim to enhance the continuity of care, foster better ​communication between healthcare professionals, and optimize the overall treatment experience for our patients.

If you are interested in pursuing ketamine infusion therapy at Forbes MediClinic, we kindly ask that you reach out to your ​primary mental health care provider to discuss the potential benefits and appropriateness of this treatment for your ​specific condition. Your mental health care provider can then initiate the referral process on your behalf.

This collaborative approach contributes to the effectiveness and safety of ketamine infusion therapy, ensuring that it ​aligns with the broader mental health treatment plan established by your primary mental health care provider.

supporting Evidence

While ketamine infusion therapy is steadily gaining attention as a promising and rapidly acting treatment for depression and ​post-traumatic stress disorder (PTSD), numerous studies and clinical trials have been providing evidence supporting its ​efficacy and safety in managing these mental health conditions for over 20 years.

Efficacy in Depression

Clinical studies have consistently demonstrated the rapid onset of antidepressant effects following ketamine infusion, with ​some patients experiencing improvement within hours of treatment initiation (Berman et al., 2000). A meta-analysis published ​in the Journal of Psychiatric Research (Zarate et al., 2012) also reported significant and sustained improvement in depressive ​symptoms following ketamine infusion therapy.

Treatment-Resistant Depression:

Ketamine has shown efficacy in individuals with treatment-resistant depression, including those who have not responded to ​traditional antidepressant medications (Zarate et al., 2006).

Long-Lasting Benefits:

Research suggests that the benefits of ketamine treatment may extend beyond the acute phase, providing sustained relief ​from depressive symptoms (Murrough et al., 2013).

Efficacy in PTSD

Ketamine may be beneficial in reducing symptoms of PTSD. Its potential to target both depressive and anxiety symptoms ​makes it a promising option for individuals with comorbid conditions. Research studies, such as the randomized clinical trial ​led by Feder et al. (2014), published in the Journal of Psychopharmacology, underscore the effectiveness of IV ketamine in ​reducing symptoms of chronic PTSD. The study reported significant improvements in PTSD symptoms - including intrusive ​thoughts and avoidance behaviours - indicating the potential of ketamine as a valuable intervention for those struggling with ​this debilitating condition.

Safety Considerations

Ketamine infusion therapy is generally well-tolerated, with few serious adverse effects reported in clinical trials (Andrade, ​2017). A systematic review and meta-analysis in the Journal of Affective Disorders (McGirr et al., 2015) found that ketamine ​was generally well-tolerated in the context of psychiatric treatment, with minimal adverse effects.

Low Risk of Dependence:

Unlike traditional antidepressants, ketamine does not appear to lead to dependence or withdrawal symptoms, making it a ​potentially valuable option for individuals who do not respond to or cannot tolerate other treatments (Niciu et al., 2018).

Monitored Administration and Safety:

The American Psychiatric Association's consensus statement on ketamine use for mood disorders emphasizes its overall ​safety profile, particularly when administered in a controlled medical setting (Sanacora et al., 2017)

supporting Evidence

Reference materials

While ongoing research is necessary to further understand the long-term effects and optimize treatment protocols, the ​existing body of evidence supports the use of ketamine infusion therapy as a valuable tool in mental health care.

• Andrade, C. (2017). Ketamine for Depression, 1: Clinical summary of issues related to efficacy, adverse effects, and mechanism of ​action. Journal of Clinical Psychiatry, 78(4), e415-e419.
• Berman, R. M., et al. (2000). Antidepressant effects of ketamine in depressed patients. Biological Psychiatry, 47(4), 351-354.
• Feder, A., et al. (2014). Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress disorder: A randomized clinical ​trial. JAMA Psychiatry, 71(6), 681-688.
• McGirr, A., et al. (2015). A systematic review and meta-analysis of randomized, double-blind, placebo-controlled trials of ketamine in ​the rapid treatment of major depressive episodes. Psychological medicine, 45(4), 693-704.
• Murrough, J. W., et al. (2013). Antidepressant efficacy of ketamine in treatment-resistant major depression: A two-site randomized ​controlled trial. The American Journal of Psychiatry, 170(10), 1134-1142.
• Niciu, M. J., et al. (2018). The role of ketamine in treatment-resistant depression: A systematic review. Current Neuropharmacology, ​16(4), 444-456.
• Sanacora, G., et al. (2017). A consensus statement on the use of ketamine in the treatment of mood disorders. JAMA Psychiatry, 74(4), ​399-405.
• Zarate, C. A., et al. (2006). A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression. Archives ​of General Psychiatry, 63(8), 856-864.
• Zarate Jr., C. A., et al. (2012). A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression. ​Archives of general psychiatry, 69(8), 827-834.
  

Inclusion Criteria for IV Ketamine

• Adult patients 18 years of age and older.

• Patients with documented Treatment Resistant Depression as defined below, who have current moderate to severe depressive symptoms. The current ​primary diagnosis, as defined by the DSM-5, is Major Depressive Disorder (MDD), or Bipolar 1 disorder or bipolar 2 disorder depressive phase.

• Individuals with Post Traumatic Stress Disorder (PTSD) or Obsessive-Compulsive. Disorder (OCD) will be considered on a case-by-case basis on referral ​from the patient’s most responsible mental healthcare provider.

• Individuals who have had previous ECT or rTMS and meet the above requirements are eligible.

• All patients must complete a medical form and be cleared for intravenous ketamine by the anesthesiologist at Forbes MediClinic.

• The anesthesiologist will review the completed medical form prior to the first infusion and any identified medical concerns will be addressed.

• The patient may be declined from receiving ketamine treatment based on their medical history.

• All patients must have capacity to sign a written informed consent for treatment.

***Treatment Resistant Depression (TRD):

The patient has failed at least two guideline concordant trials of antidepressant therapy for major depressive disorder or bipolar depression, as ​recommended in either the CANMAT MDD Guidelines 2016, Florida Medicaid Guidelines 2019, or the CANMAT ISBD Guidelines for BD 2018.***

Exclusion Criteria for IV Ketamine

• Patients with a primary diagnosis other than MDD, bipolar 1/2, PTSD, or OCD.
  

• Patients who are diagnosed with psychosis, even if it is a symptom of MDD.
  

• Patients with neurocognitive disorders, including dementias.
  

• Patients who have a traumatic brain injury that is symptomatic.
  

• Patients who, within the previous three months, meet the DSM-5 criteria for Alcohol Use Disorder, or other Substance Use Disorder.
  

• Patients who are unable to provide a written informed consent for ketamine treatment.
  

• Patients who do not meet the DSM-5 criteria for substance use disorder, but who use illicit substances, must stop all illicit substances for a minimum ​period of 1 month prior to the first infusion at Forbes MediClinic and remain free from substance use during the treatment time.
  

• Patients who are not able to abide by the pre-treatment and post-treatment clinic protocol such as: abstaining from certain medications, unable to remain ​in the clinic post-treatment for a minimum of 20 minutes or longer for observation, those who insist on driving immediately post treatment, and those who ​cannot provide Forbes MediClinic with the name and phone number of the party who will pick them up post-treatment.
  

• Patients with uncontrolled hypertension, epilepsy, allergies to ketamine, a previous reaction to ketamine, BMI greater than 40 (exceptions may be made ​after initial consultation), patients who are pregnant or planning to be pregnant within 12 weeks of treatment completion, hepatic impairment, history of ​recent heart attack, vascular disease, or other medical conditions deemed by the anesthesiologist to be a contraindication to receiving ketamine.
  

• Individuals who are symptomatic with an active infection.
  

• Individuals who are not Canadian residents or do not have a most responsible physician MRP) in Canada.
  

Physician resources

Referring physicians must:

Read and review Inclusion and Exclusion Criteria Agreement prior to sending referral

Confirm that the patient meets all of the inclusion criteria and does not meet any exclusion criteria as outlined

Confirm they are patient’s most responsible physician and will continue to be involved in this patient’s ongoing psychiatric care ​before, during, and after their Ketamine treatments

Inform Forbes MediClinic of any pertinent changes to this patient’s medical/psychiatric history that may impact their ability to safely ​undergo Ketamine Infusion Therapy

Note that Forbes MediClinic assumes no responsibility for the psychiatric component of this patients’ care and will strictly assess ​and monitor this patient as it pertains to their Ketamine Infusion Therapy

***Please fax your standard referral form (including patient identifiers, pertinent past medical history, and previous and ​current mental health treatments) to Forbes MediClinic at (506)-573-0101.***

About us

Dr. Stewart Forbes is a specialist in anesthesiology and a Fellow of ​the Royal College of Physicians and Surgeons of Canada. After ​completing medical school and his anesthesiology residency at ​Dalhousie University, Dr. Forbes began practicing at The Moncton ​Hospital, delivering general and regional anesthetics to patients ​for a wide range of surgical sub- specialties.

Dr. Forbes has long held a particular interest in the potential ​benefits of utilizing ketamine to treat mental health conditions. ​In light of rapidly emerging evidence supporting this treatment, ​Dr. Forbes established Forbes MediClinic in 2023 to improve ​access to ketamine infusion therapy for patients in the Maritimes ​suffering from mental health issues.

Dr. Stewart Forbes BSc, MD, FRCPC

Contact us

Email: forbes.medical.inc@gmail.com

phone: (506) 378 - 8808

fax: (506) 573 - 0101

MONcton Health Collaborative building

277 john Street, Moncton NB

For referring physicians:

***Please fax your standard referral form (including ​patient identifiers, pertinent past medical history, and ​previous and current mental health treatments) to ​Forbes MediClinic at (506)-573-0101.***

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