Esketamine is normally administered via nasal spray to patients for the treatment of depression (Photo courtesy of flickr/Creative Commons)
Major depressive disorder is an ailment that currently afflicts 16 million Americans and nearly 300 million people globally, often leading to suicidal ideations and attempts. Depression is the leading disability worldwide, while suicide is the 10th most common cause of death in the United States and the only one on the rise. Of the 300 million people with this disorder, roughly one-third suffer from treatment-resistant depression, enduring the suffocating weight of a potentially life-threatening mental illness. Last week, the Food and Drug Administration (FDA) approved the use of a new antidepressant, esketamine, which has the potential to reduce depressive symptoms mere hours after administration. While this may sound like a near-miraculous treatment, the administration of esketamine is controversial.
Esketamine is a chemical compound that is structurally very similar to ketamine, a common anesthetic. Although ketamine is officially sanctioned as an anesthetic and not an antidepressant, it is legally prescribed by psychiatrists to treat depression. Both drugs, however, have potentially harmful side effects including hypertension, sedation and dissociation, the latter of which is why ketamine has been used as a party drug under the nickname “Special K.” Therefore, the FDA has mandated systems to be set in place to monitor any unwanted symptoms and prevent substance abuse. Patients will only be allowed to receive esketamine, to be marketed as Spravato, as a nasal spray at an approved treatment location under the supervision of a healthcare provider. Since the drug may not be taken home, the chances of abuse and overdose are slim. Supervision also ensures prompt assistance should any side effects occur.
Another potential barrier to the acceptance of esketamine as an antidepressant is the cost, which is estimated to be between $590 to $885 per administration, required twice a week for the first month and once a week moving forward. Fortunately, FDA approval increases the likelihood of insurance coverage of esketamine, an option not extended to ketamine, which lacks the backing of the FDA. Therefore, if covered by insurance, esketamine could actually become a more affordable treatment for patients presently being prescribed ketamine and others who have not yet found a treatment for their depression.
Perhaps the most significant factor regarding the utilization of esketamine is the question of the medication’s efficacy. Out of the three studies presented to the FDA investigating the short-term results of the drug, only one trial showed significant effectiveness. Nonetheless, although a corroborating short-term study was absent, a maintenance study supported the success of esketamine long-term. This shows promise in the possibility of the drug as an effective medication in cases of depression that have been thus far unresponsive to treatment. Furthermore, esketamine has been approved for supplemental usage alongside another oral antidepressant; to be safe, the usage of other antidepressants will not be discontinued for patients prescribed esketamine.
Despite some apprehension concerning the administration of esketamine as an antidepressant following its official approval by the FDA, the drug appears to have the potential to help people in need. As with any medication, the situation thus calls for a weighing of the risks and the rewards. Esketamine’s quick effect time could potentially save the life of a desperately suicidal patient. The side effects may be worrying, but as they were not observed in every case, it is reasonable to attempt treatment with esketamine in patients under vigilant supervision. Studies have shown that the drug has provided relief for some patients. For that reason, if there is even the chance that esketamine could help lift someone out of the depths of a seemingly untreatable depression, then it is worth moving forward for patients unresponsive to conventional treatments, with the hopes of observing a positive outcome.
Veronica Eskander is a campus correspondent for The Daily Campus. She can be reached via email at veronica.eskander@uconn.edu.
