Medics divided on depression treatment based on ‘party drug’ ketamine
▶ Nasal spray esketamine will be available in the UAE from March
A fast-acting, ketamine-based nasal spray could offer hope to thousands of people with depression when it is introduced in March.
Esketamine is described by doctors as a medicine that must be used in a controlled environment because of its psychoactive properties.
Although the treatment will provide doctors with another weapon against depression, psychiatrists are split on how effective it might be.
With more people seeking help as the stigma surrounding mental health fades, psychiatrists hope the treatment – sold under the brand name Spravato – will offer a lifeline to those who have experienced little improvement from established drugs such as Prozac.
Other doctors have said the drug could be abused or lead to addiction, although it is expected to be strictly controlled. Ketamine’s reputation as a party drug has caused reticence and confusion about the treatment.
“The reservations have included the potential for abuse and dependence, as well as the cost factor,” said Dr Saeed Islam, a consultant psychiatrist at the Priory’s Middle East clinic.
“Unlike conventional antidepressants which can take three to four weeks to show improvement in depressive symptoms, this drug can produce positive changes within hours.
“The cost is still an issue and it will remain a treatment option for a few patients only.”
Other risks listed on medical licensing documents include a chance of transient perception disorders, disturbances in consciousness, cystitis and increases in blood pressure.
A group of 12 psychiatrists in the UK expressed reservations to regulators, claiming short-term improvements similar to recreational drugs should not have been used as a basis to approve esketamine as a treatment for depression.
Doctors described the drug as a “breakthrough” when it was announced that Spravato would be made available in the UAE this year.
Although traditional antidepressants work by boosting serotonin – a neurotransmitter thought to have a good influence on mood, emotion and sleep – in the brain, Spravato is the first drug in decades to target a new brain pathway: glutamate.
Glutamate is a neurotransmitter that plays an important role in learning and memory and is considered essential for normal brain function.
But treatment will not be cheap, and is expected to cost about $600 (Dh2,200) a session.
In the US and Europe, the drug costs between Dh17,000 and Dh25,000 in the first month, falling to Dh8,700 to Dh13,000 monthly. Medication would be free for Emiratis and some other insurance plan holders.
It is produced by Johnson & Johnson’s Janssen Pharmaceuticals and was approved by the US Food and Drug Administration in March.
The UK’s National Institute for Health and Care Excellence is expected to decide if esketamine will be made available on the National Health Service early next year.
It is also recommended by a European Medicines Agency panel based on a series of longterm trials.
When given esketamine, researchers found patients had a 51 per cent lower risk of relapse than those given oral antidepressants and a placebo spray.
Esketamine is expected to be in use at Abu Dhabi’s Sheikh Khalifa Medical City from March.
“We are very much aware of this drug since its FDA approval and its potential benefits to patients,” said Dr Padmaraju Varrey, a psychiatrist at NMC Hospitals.
Dr Varrey treats about 20 patients a week but not all are suited to existing drugs, he said. “We are looking forward to the availability of this medicine to help more patients in Abu Dhabi.”