Anesthesiology

A mind-altering medication relate to the club drug Special K won U.S. approval Tuesday for patients with hard-to-treat depression, the first in a series of long-overlook substances being reconsidered for severe forms of mental illness. The nasal spray from Johnson & Johnson is a chemical cousin of ketamine, which has been used for decades as a powerful anesthetic to prepare patients for surgery.

Various insurance

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 Food and Drug Administration 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; hospitalization and other serious harm, according to the FDA.

The drug will cost between $590 and $885 depending on the dosage and before various insurance discounts and rebates. 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.

Psychiatric questionnaire

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 depress patients are very disable 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 design to be lower-dose and easier to use than ketamine; which is normally give as an intravenous infusion. Robin Prothro, 60, began taking antidepressants more than 20 years ago. But she says none of the five medications she try relieve the depression that has stymied her personal and professional life.

Potential treatments

Since enrolling in a Spravato trial two years ago; Prothro says her depression is lift and she’s return 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 colors 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.