Breakthrough nasal spray depression treatment coming to the UAE next year

A breakthrough medication used to treat depression will be available in the UAE next year.

The drug, called esketamine, will be sold under the brand name Spravato and is one of the first fast-acting medicines to treat the chronic condition.

Produced by Janssen Pharmaceutica, a single puff in each nostril has shown to improve a patient’s mental health within 24 hours.

It was approved in March by the Food and Drug Administration, the US drugs regulator, and last week won recommendation for approval from a European Medicines Agency panel.

It is expected to be available at Abu Dhabi’s Sheikh Khalifa

Medical City as early as March next year.

Doctors are optimistic that Spravato will help patients who have not responded to two other conventional antidepressants, which can take weeks to have an effect.

“This medication works within four hours and is taken two to three times a week. It is not available [in the UAE] yet but we are working on making it available as soon as possible. Patients who have used it have reported improvement,” said Dr Medhat Elsabbahy, head of psychiatric rehabilitation at SKMC. Dr Elsabbahy was speaking at the Abu Dhabi International Mental Health Conference on Thursday.

Traditional antidepressants work by boosting serotonin levels – 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, a neurotransmitter that plays an important role in learning and memory and is considered essential for normal brain function.

It is hoped the new medicine will be of particular use to patients who struggle to follow a medication regimen.

“One of the major problems we face with patients is compliance with medication,” said Dr Tarek Darwish, consultant psychiatrist and medical director of SKMC’s Behavioural Sciences Pavilion. “Patients are at

risk of relapsing if they stop the medication and so the current direction is towards medicines whose effects are long term, such as … the nasal spray.”

The spray is should be taken with an oral antidepressant.

The drug costs between Dh17,000 and Dh25,000 in the first month and falls to a monthly amount of between Dh8,700 and Dh13,000 for patients in the US and Europe.

Medication is free for Emiratis and some insurance holders but, because the drug has still to be registered in the UAE, its local cost has not yet been determined. To prevent abuse, the drug will be tightly monitored in the UAE.

“It will be used on patients suffering from severe depression and who are not responding to other medications, but it is too early to tell how it will be administered because it has not arrived on the market yet,” Dr Darwish said.

Spravato is regarded as part of a new class of fast-acting, long-lasting medications to treat mental health disorders.

Other breakthrough drugs include injections used to treat schizophrenia and bipolar disorder that are to be taken every three months instead of the traditional daily tablets.

“We have been in the field of psychiatry for 50 years. The nasal spray is our latest medication,” said Janssen representative, Magdy El Hameed.

He said the drug could initially be used once a week and later administered once every two weeks.

“For esketamine to be abused, the patient will need to take 300 puffs at the same time and that is not feasible. Each canister contains one puff,” he said.

There were initial reservations about the medication over its links to ketamine, a drug with a reputation for recreational misuse, although ketamine has been used to treat depression, as well as serving as an anaesthetic.

Depression affects an estimated 350 million people across the world, and more women are affected than men.

In the Arab world, it is estimated that on average, 17.7 per cent of the population suffers from depression.

The UAE government has said this figure was likely to only be the tip of the iceberg because not everyone with mental health issues was comfortable enough to come forward and seek treatment due to the associated stigma.

Professor Ahmed Okasha, founder of the Institute of Psychiatry at Ain Shams University in Cairo and adviser to the Egyptian president for mental health and community integration, said stigma remains a huge problem across the globe, particularly in the Arab world.

“We want to explain in two words that mental illness is a disease in the brain,” he said.

“It is not mystical like people believe it to be; it is not caused by jinn, the evil eye or bad spirits. It is exactly like any organic disease.”

He said stigma endured because patients were often kept in hospitals by their families who believed them to be harmful to others.

“Mentally ill people are discriminated against; they are isolated and hated when they should be treated like any member of society,” he said.