Promising results of Ketamine Nasal Spray for treatment-resistant depression

Promising results of Ketamine Nasal Spray for treatment-resistant depression

Nasal Spray Beats Standard Drug for Treatment-Resistant Depression: A Breakthrough in Treating a Challenging Condition

Depression Slideshow

A new clinical trial has found that a nasal spray containing a ketamine derivative could be a game-changer for people with difficult-to-treat depression. The trial, which involved nearly 700 participants with treatment-resistant depression, found that esketamine nasal spray was more effective at sending patients into remission than the standard oral drug quetiapine (Seroquel).

Depression is a common mental health condition that affects millions of people worldwide. While many individuals find relief with standard antidepressant medications, a subset of individuals, estimated to be around 30% of those with depression, have what is known as treatment-resistant depression. This means that their symptoms persist despite trying at least two different antidepressants. Such individuals are at increased risk of hospitalization and suicide, making finding effective treatments crucial.

The United States has a few medications that are approved as an “augmentation” therapy for treatment-resistant depression, which means they are used in combination with standard antidepressants to enhance effectiveness. Quetiapine is one such medication, and esketamine nasal spray is another, which has been available since 2019 under the brand name Spravato.

The approval of Spravato was based on previous research that compared esketamine to a placebo nasal spray. However, the recent clinical trial is the first to compare esketamine to another commonly used add-on drug, quetiapine. Lead researcher Dr. Andreas Reif, head of psychiatry at University Hospital Frankfurt-Goethe University in Germany, stated that the trial’s findings provide valuable data to inform long-term clinical decision-making for a large patient population.

The trial found that after eight weeks, 27% of the participants using esketamine nasal spray were in remission, compared to 18% of those using quetiapine. By week 32, half of the esketamine users were faring well, compared to one-third of the quetiapine users. These results strengthen the case for esketamine as a promising option for people with treatment-resistant depression.

It is important to note that esketamine is not suitable for everyone, and individuals should work closely with their healthcare provider to determine the best course of treatment. Esketamine, like its parent drug ketamine, was initially approved as an anesthesia medication and has dissociative effects at higher doses. Due to its potential to cause mind-altering symptoms, ketamine has also been abused as a recreational drug. However, at low doses under medical supervision, ketamine and esketamine have demonstrated potential in treating psychiatric symptoms, including depression.

Esketamine nasal spray, like its parent drug, requires medical supervision during administration to monitor for side effects such as blood pressure spikes and sedation. It is not available for at-home use and requires a commitment from patients. The usual dosage schedule is twice a week for the first month, then weekly for the second month, and weekly or every two weeks thereafter.

One of the notable advantages of esketamine is its relatively fast-acting nature. Unlike many traditional antidepressant medications that can take months to produce noticeable effects, esketamine often yields positive results fairly quickly. This is because ketamine and esketamine work through different mechanisms compared to existing antidepressants. Research suggests that ketamine and its derivatives enhance activity in a chemical called glutamate, promoting communication among brain cells. They may also facilitate the regrowth of synapses, connections between brain cells that may be diminished in people with long-standing depression.

However, despite the positive findings from this trial, esketamine is not a cure-all for treatment-resistant depression. It is merely another viable option for a condition that desperately needs more effective treatments. According to Dr. David Hellerstein, a professor of clinical psychiatry at Columbia University Irving Medical Center, the decision on treatment options needs to be individualized based on each person’s specific needs and circumstances.

While esketamine shows promise in the treatment of treatment-resistant depression, there are some obstacles to consider. The cost of the medication can be prohibitive, and the inconvenience of regular medical supervision can also be a challenge. Nonetheless, the availability of esketamine nasal spray as a potential remedy for those who haven’t responded to other treatments offers hope and reinforces the need for continued advancements in mental health care.

In conclusion, the recent clinical trial comparing esketamine nasal spray to a standard drug has highlighted its superior effectiveness in sending patients with treatment-resistant depression into remission. While esketamine is not without its drawbacks and considerations, its potential to provide relief to those who have struggled to find relief from depression is a significant step forward. The findings of this trial have the potential to influence medical practice in many countries, benefitting a large patient population and improving outcomes for individuals suffering from treatment-resistant depression.

More information: HealthDay – Ketamine/Esketamine for Treating Depression

Sources: Andreas Reif, MD, head, psychiatry, psychosomatic medicine and psychotherapy, University Hospital Frankfurt-Goethe University, Frankfurt, Germany David Hellerstein, MD, professor, clinical psychiatry, Columbia University Irving Medical Center, research psychiatrist, New York State Psychiatric Institute, New York City New England Journal of Medicine, Oct. 5, 2023