Ketamine Has Been Approved To Treat Depression
A form of ketamine has been approved by the U.S. Food and Drug Administration as a treatment for depression.
Esketamine, developed by Johnson & Johnson and produced as a nasal spray, can only be administered in a doctor's office.
It's a rapid-acting anaesthetic that has been used illegally as a party drug known as "Special K". Now, J&J is touting it as the first new drug treatment approved for depression in decades.
The nasal spray is a chemical cousin of ketamine, which has been used for decades as a powerful anaesthetic to prepare patients for surgery.
In the 1990s, the medication was adopted as a party drug by the underground rave culture due to its ability to produce psychedelic, out-of-body experiences.
More recently, some doctors have given ketamine to people with depression without formal FDA approval.
The FDA approved Spravato as a fast-acting treatment for patients who have failed to find relief with at least two antidepressants.
Up to 7.4 million American adults suffer from so-called treatment-resistant depression, which heightens the risk of suicide, hospitalisation and other serious harm, according to the FDA.
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There have been no major pharmaceutical innovations for depression since the launch of Prozac and related antidepressants in the late 1980s. Those drugs target the feel-good brain chemical serotonin, and can take weeks or months to kick in.
Ketamine and J&J's version work differently than those drugs, targeting a chemical called glutamate that is thought to restore brain connections that help relieve depression.
When the drug works, its effect is almost immediate.
That speed "is a huge thing because depressed patients are very disabled and suffer enormously," said Dr John Mann, a psychiatrist and researcher at Columbia University.
If the drug doesn't work, physicians can quickly switch to other options, he noted.
The FDA approved Spravato, known chemically as esketamine, based on study results that showed patients taking the drug experienced a bigger improvement in their depression levels than patients taking a sham treatment, when measured with a psychiatric questionnaire.
The drug is designed to be lower-dose and easier to use than ketamine, which is normally given as an intravenous infusion.
Robin Prothro, 60, began taking antidepressants more than 20 years ago. But she said none of the five medications she tried relieved the depression that has stymied her personal and professional life.
Since enrolling in a Spravato trial two years ago, Prothro said her depression has lifted and she's returned to hobbies she abandoned years ago, like gardening.
She takes the drug every two weeks at her psychiatrist's office while reclining in a comfortable chair.
"You can feel it coming on, it's a strong drug," she said, describing colours and shapes that drift before her eyes.
"I just let the drug work. I close my eyes and my mind is amazingly quiet."
The ketamine-like drug is the first of several psychoactive substances making their way through the U.S. regulatory process as physicians search further afield for new therapies.
Researchers are conducting late-stage trials of psilocybin, the active ingredient in magic mushrooms, and MDMA, a euphoria-inducing club drug, as potential treatments for depression and post-traumatic stress disorder.
"Substantially different agents are only rarely appearing from pharmaceutical companies or other laboratories," said Dr Paul Summergrad, a psychiatrist at Tufts University.
"That's prompting people to investigate other compounds."
Unlike ketamine, psilocybin and MDMA have no legal medical use. Classified in the same category as heroin and LSD, they are tightly restricted by the federal government. But the FDA's approval of esketamine could smooth their path.
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