You may have heard the news that a new type of treatment for depression has been FDA-approved. Unlike oral antidepressants, this one is fast-acting and the results of extensive studies have shown that it is an effective option for treatment-resistant depression. Part of the reason why it is making waves in the field of mental health is the fact that it is closely related to the party drug ketamine, otherwise known as “Special K.” Can ketamine nasal spray help you? Here is some information on depression, traditional antidepressants, and on how the ketamine nasal spray is a significant new addition to the treatment arsenal.
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What is Depression?
Depression is a common mental illness that affects your thoughts, feelings, and behaviors. People suffering from depression experience feelings of deep sadness and despair, have negative thoughts (often including thoughts of self-harm and suicide) and they exhibit related behaviors. They struggle to find motivation for both work and leisure, often choosing to stay home (or in bed) rather than facing a troubling world.
Traditional Treatments for Depression
Traditionally, depression (and its symptoms) has been treated using antidepressants and therapy. Both of these depression treatment options have evolved over the past century or so. The field of therapy, which was once dominated by Freudian psychoanalysis, has become far more patient-centered and practical. It has also embraced Eastern mindfulness principles and methods.
The antidepressant market has been dominated by SSRIs, which help to increase the levels of the hormone serotonin in the body. Serotonin helps to regulate mood in patients with depression, among other important functions. Other types of antidepressants that you can find these days include some which increase levels of dopamine (such as Wellbutrin) as well as the more outdated “tricyclic” antidepressants.
While these antidepressants have helped millions of people worldwide, they do not help everyone (and this includes patients with severe depression). Furthermore, there can be significant side effects as well as long-term effects that patients with depression have to live with. Also, they take two to six weeks to begin working fully, which can be too long in severe depression cases.
Some people simply do not respond to therapy or antidepressants. This is what is referred to as treatment-resistant depression. For years, people suffering from treatment-resistant depression have had few to no alternatives to traditional treatments.
Ketamine for Depression
The new ketamine nasal spray is exciting because it can help people suffering from treatment-resistant depression and it doesn’t have some of the drawbacks of traditional antidepressants.
For many years, before FDA-approval, certain practitioners have been providing intravenous ketamine doses to patients suffering from treatment-resistant depression. They administered low doses and saw immediate results.
They also found that the effect of ketamine infusion therapy was long-lasting. Patients required no more than one dose a week or one dose every other week. Unlike traditional antidepressants which need to be taken daily to have a significant effect.
Over the past few years, researchers found that ketamine in low doses “binds to NMDA-receptors, blocking their re-uptake of the excitatory neurotransmitter glutamate.” This further activates AMPA receptors which strengthen synapses in the areas of the brain that regulate motivation and mood, as well as memory.
Side effects of ketamine can include nausea, dizziness, vertigo, lethargy, anxiety, feeling drunk, increased blood pressure, vomiting, decreased sensitivity, sedation and dissociation. However, these side effects can generally be managed easily and they are only temporary. Since a dose of ketamine is only administered by a medical practitioner (and only 2 to 4 times a month), they should not have a significant impact on an individual’s daily life.
Ketamine Nasal Spray
Aside from being delivered intravenously, a ketamine nasal spray is another method of delivery. Intranasal Ketamine has been used by ketamine clinics for years, and have had the same impact as intravenous ketamine. An immediate effect with few side effects.
Ketamine itself has long been on the market in other forms. It was used as an anesthetic for humans and animals. For this reason, pharmaceutical companies had little incentive to create antidepressants using the same compound. Esketamine, however, is closely related and works in the exact same way.
FDA Approval of Esketamine
This has led to three rounds of research over the past several years, the third being completed recently. The FDA has, as of March 6th this year (2019), approved esketamine for use in treating depression.
When Will Esketamine Be On The Market?
Esketamine nasal sprays will not be on the market in the same way as traditional antidepressants. Patients will not be able to take the substance home with them. Rather, it will be administered by professionals in clinics. Patients will visit clinics every week or every other week (depending on their needs) where they will receive their dosage. They will then be monitored for any ill effects for the following two hours, especially since the immediate effects of sedation and vertigo can make it difficult for them to get home safely. It will be marketed as Spravato™ and should be available in clinics in the near future.
A Quick and Effective Treatment Option?
The esketamine nasal spray could provide a quick and effective treatment option for depression (even for treatment-resistant depression). Rather than waiting two to six weeks to see if an antidepressant works, patients will know almost immediately whether there has been an effect and they will continue experiencing the benefits for a prolonged time.
There are still obstacles in the way of esketamine nasal spray becoming the go-to treatment option for depression. Insurance companies will take a bit of time to decide on the amount they will pay for the treatment. Furthermore, the esketamine nasal spray (Spravato™) is very expensive. One treatment session will cost between $590 and $885.
Ketamine, on the other hand, is far more affordable. However, since pharmaceutical companies have little interest in marketing it, it will probably not be on the market in the foreseeable future. But, since ketamine clinics are technically legal, it is still possible to receive treatment if there is one in your area. Just remember that insurance companies are unlikely to cover this.
The approval of the esketamine nasal spray (to treat depression) is a huge step in the treatment of mental illness, regardless. It finally provides a qualitatively different alternative to traditional antidepressants, and it can help many people who have (until now) found no end to their suffering. This news could also encourage research in other types of potential treatments that differ from the status quo.