The People's Perspective on Medicine

What Should You Know about New Antidepressant Spravato?

FDA has approved a new antidepressant, esketamine. It will be available as Spravato nasal spray for people who have not responded to other drugs.

The Food and Drug Administration approved a completely new type of antidepressant on March 4, 2019. This ended several weeks of speculation. A nasal spray called esketamine is expected to help people who have not responded to standard antidepressants. It will be marketed under the brand name Spravato.

What Is Esketamine (Spravato)?

This drug is chemically related to the injectable anesthetic ketamine that has been on the market since 1970. Ketamine is available generically. It has been used off-label for pain and treatment-resistant depression (Schoevers et al, British Journal of Psychiatry, Feb. 2016). One disadvantage of ketamine as an anesthetic is that it can cause a dissociative state while it is wearing off. Many people find this alarming. (Others enjoy this sensation, explaining ketamine’s popularity as a club drug, “Special K.”)

Drug company Johnson & Johnson developed esketamine following reports that infusions of ketamine itself could lift depression quickly (Andrade, Journal of Clinical Psychiatry, Mar/Apr. 2018). In particular, ketamine had a strong effect on suicidal thoughts (Ballard et al, Journal of Psychiatric Research, Nov. 2014). Many people who have not overcome depression with older antidepressants might benefit from Spravato, first in its class.

How Will People Use Spravato?

Although eskatamine is administered as a nasal spray, people will not be permitted to purchase it for home use. To guard against abuse, patients will need to use Spravato under medical supervision at a clinic or doctor’s office. J&J recommends that people use it twice a week for four weeks. The company estimates the cost for a month’s treatment between $4,720 and $6,785. 

Some experts have challenged the FDA’s approval process for esketamine. While two clinical trials demonstrated some benefit, two others did not show that esketamine is better than placebo. The drug may work a bit better for adolescents and young adults than for older adults.

What Are the Side Effects of Spravato?

This novel antidepressant can cause nausea, dizziness, headache and a feeling of dissociation. Spravato can also trigger an unpleasant taste in the mouth. Some people in the clinical trials reported vomiting, anxiety, numbness or tingling in hands or feet and drowsiness (Canuso et al, AJP in Advance, 2018).

To learn more about ketamine and its use against suicidal thoughts, you may wish to listen to Show 983: Intriguing Approaches to Overcoming Depression.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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Louise, dissociation from reality is not necessarily a pleasant sensation. Some forms of dissociation can be part of a psychotic disorder. Hopefully, this sensation passes quickly with the use of Spravato, as I would assume that it would not have been approved if dissociation was a persistent effect.

The bigger issue here, of course, is the price. It will be interesting to see if insurance companies cover it.

I was told that it costs more than $5,000 per month: Depressing indeed! Ask your doctor.

Right on.

Ketamine has been used as an anesthetic by vets, surprising owners when their pets wake up paranoid and snarling. Ditto when humans come out of aneshesia if it has been used. THIS IS NOT HELPFUL!!

At a cost ranging from $157.33 to $226.16 per day, Obviously this excludes at least 95% of those in the U.S. of A. from the benefits of this drug, which is a spin off from Ketamine, which has been marketed for the past 49 years.

This is where my support for a capitalist government ceases !
Here we have millions of people living lives of doom and gloom, lives filled with no hopes for a normal tomorrow because current antidepressant drugs have failed them in their losing battle against overwhelming sadness, the level of which renders them victims, helpless in being able to live normal lives.

Surely, this was not the intention of the framers of our Constitution !

Anybody would feel better and depression lifted if they dissociated from reality. Leave it to the crooked politicians and drug peddlers to approve this drug.

Another outrageously expensive medication. The cost alone could very well be a contributing factor to depression.

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