When Ihor Kholodylo first arrived for ketamine treatment at a Kyiv clinic in 2015, he could barely speak.
In 2014, the combat medic had been evacuating wounded Ukrainian soldiers from the frontlines when his vehicle was struck by a Russian tank shell, leaving him with severe physical injuries, post-traumatic stress disorder and a debilitating stutter.
“I had this idea that I’m quite tough … a warrior,” said Kholodylo, who is today 58. “But the reality was the opposite. I had all the symptoms of PTSD.”
Conventional treatments brought little relief. And so when Kholodylo was invited to participate in a study on ketamine therapy for combat-related PTSD, he was eager to give it a try.
Ketamine, a legally approved anesthetic in Ukraine, is increasingly used worldwide to treat treatment-resistant depression and trauma.
Kholodylo is one of many Ukrainian veterans who have seen breakthroughs with this therapy. But Canada, home to world-class psychedelic researchers and clinicians, lags behind.
Experts hope this will change.
“Westerners could learn from Ukrainians when it comes to PTSD and trauma-care infrastructure,” said Yuriy Blokhin, a Canadian-Ukrainian board member of Heal Ukraine Trauma (HUT), a nonprofit that supports veterans and their families with psychedelic-assisted therapy.
Meeting death
Kholodylo, who served in Ukraine’s Anti-Terrorist Operation from 2014 to 2016, may have suffered more intense battlefield experiences than some.
But the Ukrainian population at large is struggling with the effects of nearly four years of war.
Ukrainians suffer from high rates of PTSD, depression, anxiety and addiction. For veterans, these conditions can be especially severe.
“A heavy traumatic experience does not allow you to live in reality,” said Kholodylo. “You are living in the past … PTSD actually steals the ‘now’.”
Ketamine produces psychedelic-like experiences that can help temporarily loosen the brain’s fear circuits and rigid thought patterns. This allows patients to access, feel and talk about traumatic memories in ways that might otherwise be overwhelming.
“When war comes to your life, it lives inside you, forever,” said Kholodylo. “It’s about [increasing] neuroplasticity,” he said, noting the drug creates “a window of opportunity” for therapy to work. Veterans learn to live with their memories, rather than suppress them.
Kholodylo describes his own ketamine-assisted psychotherapy sessions at Ukraine’s Expio Clinic as intense and confrontational.
Over several weeks, he and other patients progressed through low- and full-dose ketamine sessions. Each session was followed by group and individual therapy to process their experiences.
“The first session was mostly about war — about your friends, soldiers … fragments from my memory … about losing guys we cannot bring back,” Kholodylo said.
“It’s also about the guilt — we survived, and they did not.”
The immediate effects of a single dose of ketamine typically last about an hour. But its therapeutic benefits on mood can persist for days to weeks.
Kholodylo’s sessions, held every few days, grew progressively deeper. By his third session, the therapy pushed him to the edge, forcing him to confront survivor’s guilt and the weight of his battlefield experiences.
“You meet death personally, and she smiles at you,” he said. “The final result … is that you understand that you are part of everything, and everything is part of you.”
Kholodylo and others stress that group therapy and peer support are an essential part of the process. “[With] PTSD … you put yourself in a bubble … you don’t have people that you can talk to,” said Kholodylo.
“[Group therapy] is a circle of people that are ready to support each other, and they not only listen to each other, they understand each other. Sometimes they understand each other [by] just looking at each other.”
Dr. Oleksandra Kasianova, a psychiatrist and psychotherapist at the Ukrainian NGO United Humanitarian Front, added: “This part of sharing is very important. The group dynamic makes insights deeper [and] creates that sense of belonging to the group,” she said.
“Sometimes … their brother in arms literally died in their hands.
“We also work with people that were in captivity … [which is] a very strong, traumatic event because Russian [soldiers] tried to destroy their sense of identity, personality and sense of freedom.”
Kasianova notes that not everyone is a good candidate for ketamine-assisted therapy.
Some veterans are ineligible due to hypertension or a history of epilepsy. Others lack stable family support.
“The psychedelic process is a very deep process, and people should have a place and time to process all the feelings and experiences,” said Kasianova.
For Kholodylo, ketamine-assisted therapy actually improved the dynamics in his own family.
“There is more love, more pleasure. [My wife] tells me she feels it.”
And he quickly saw physiological improvements as well. After his fourth session, his stutter began to fade.
“After [the] fourth session of ketamine, I started to talk,” he said.
Psychedelic-assisted therapy
In Ukraine, ketamine-assisted therapy is already legal. In April, Ukraine passed a law aligning the country’s controlled substance rules with EU standards, a move that could pave the way for clinical trials of other psychedelics.
By contrast, Canada maintains strict controls on psychedelics such as psilocybin and MDMA, confining their use largely to clinical trials or special access exemptions.
Ketamine is legal and prescribable in Canada, but psychedelic-style ketamine therapy is only available at a few specialized clinics, meaning few veterans can access it.
Oksana Gryshchenko, HUT’s Ukraine director who grew up in Montreal, says that ketamine-assisted therapy is a method of last resort, used to treat trauma that has not responded to other forms of treatment.
“We’re about mental health [first],” she told Canadian Affairs during an in-person interview in Kyiv. “The reason HUT went into psychedelics is because … all the existing therapies were only able to do so much.”
Kholodylo can attest to this. Before ketamine, he tried psychotherapy and even researched illegal psilocybin treatments. Nothing eased his war-induced stutter.
But after just ten sessions of ketamine-assisted therapy, he felt a return to normalcy.
Today, Kholodylo has turned his recovery into a way of helping others. He now serves as a peer-support therapist at HUT, helping other veterans navigate ketamine-assisted therapy and guiding them through the process he once experienced himself.
‘A world leader’
One of HUT’s key challenges is meeting demand in a war-torn population. The nonprofit currently has 24 therapists trained to deliver ketamine‑assisted therapy and is working to expand rapidly.
Blokhin, of HUT, says he foresees Ukraine becoming a leader in psychedelic-assisted therapy.
“I envision Ukraine as a world leader in psychedelic trauma care,” he said.
Dr. Olga Chernoloz, a neuroscientist and clinical pharmacologist at the University of Ottawa, agrees. “Once Ukraine starts dabbling in this, it will become a leader within the next five years,” she said.
“Practitioners will start coming to Ukraine and learning from Ukrainians.”
But Canada, she says, is a different story.
“Changes are definitely happening, but there is quite a bit to be done in Canada,” she said. The regulatory processes for psychedelic trials have been slow and cumbersome, in a way that can impede clinical innovation.
Blokhin notes that wartime urgency has created space for rapid innovation in Ukraine. “There is … a lot less risk aversion [in Ukraine] because things already are bad enough,” he said.
Canada lacks that sense of urgency, at least for now.
“[In Ukraine], we don’t have time for 10 years of waiting; while here [in Canada,] people are afraid to sneeze,” he said.
“The problem is ultra risk aversion and lack of leadership.”
Kholodylo says Ukraine must be ready to support a coming “tsunami” of veterans needing care after the war.
“Tsunami is a wave that you do not see … and then it’s too late,” he said. “If around a million soldiers come back, plus family members … that’s a huge number.
“We need more therapists.”
Perhaps if this treatment is allowed to treat mental health issues in Canada, we may not have so many people with addition problems. Just a thought.
Thank You for this post.