Neuroscientists explore use of ketamine to treat depression

Modesto Morganelli
Marzo 12, 2019

The drug is a nasal spray created to treat severe forms of depression that don't respond to other treatments.

A nasal spray containing chemicals closely related to ketamine has been approved for use in the U.S. in the treatment of depression - but it will be highly regulated to avoid misuse of the drug.

Spravato can only be administered in a doctor's office. Critics are anxious, however, that the drug will have a high potential for abuse, like its cousin ketamine.

In the short-term study, the spray demonstrated statistically significant effect compared to placebo on the severity of depression, and some effect was seen within two days. "The threshold has been two adequate and well-controlled trials".

The drug will only be given by accredited specialists who must monitor patients for at least two hours after administration, due to its trippy, disorienting effects.

"My concern is that we don't really how it gets people un-depressed", Mark George, MD, a psychiatrist and neurologist at the Medical University of SC in Charleston, tells Health.

Spravato will cost between $590 and $885 per treatment.

The treatment is only available through a restricted distribution system, under a Risk Evaluation and Mitigation Strategy (REMS), because of the risk of adverse outcomes resulting from sedation and dissociation. But many advocates are hopeful that the treatment can bring relief to the most desperate patients. "It really has opened up a whole new way of thinking about depression", Gerard Sanacora, professor of psychiatry at Yale University School of Medicine and director of the Yale Depression Research Program, said of ketamine. At least 150 clinics around the US provide treatment with various forms of the drug, which is available as a low-priced generic.

The list price of a drug is not necessarily what patients actually pay. Such therapies are generally not covered by insurance because they haven't been approved as safe and effective by FDA regulators.

Some doctors plan to offer both ketamine and the new J&J drug.

Approval of the drug, which will be sold by J&J as Spravato, gives a new treatment option for individuals who have previously failed two or more antidepressants, a population that is estimated to account for roughly a third of the 16 million adults in the us who have had an episode of major depressive disorder.

Esketamine is closely related to ketamine, an anesthetic approved in 1970 that's more commonly known for its recreational use.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute's Department of Science Education.

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