Ketamine has been going through an image transition. Originally created to be a medical anesthetic, it soon became popular as a party drug known, as Special K. Its illicit street use gave it a bad rap, but in recent years doctors have been going off label using it to treat depression. Ketamine infusion therapy is now a popular alternative depression treatment and has shown promise for a number of other disorders such as suicidal behavior too.
As the number of positive case studies mounted, the FDA put two ketamine-based pharmaceuticals on the approval fast track. Johnson & Johnson has been working on a nasal spray form of esketamine (a specific type of ketamine) for the treatment of treatment-resistant depression. Called Spravato, the spray would make ketamine treatments more affordable and easier.
Last week the FDA recommended the approval of Spravato in a 14-2 vote. The committee determined the spray had a favorable benefit-risk profile. Research on the drug found that it greatly improved depression symptoms when used alongside a traditional antidepressant.
However, there are downsides. The drug, as with traditional ketamine infusion therapy, has sedative and dissociative side effects. Because of this, the committee suggests administration of this spray should be only at a medical facility. This means patients would still need to go to the doctor. While this is a hurdle, Spravato will be safer, quicker, and cheaper than infusions. It’s expected that if the drug performs well the program may become more flexible.
Many are concerned about the risk of addiction, especially since ketamine is still a popular party drug. So far ketamine infusion therapy hasn’t resulted in increased addiction, however, it’s so new that there isn’t any long-term data. By administering it intranasal though, the drug bypasses the liver and other organs, allowing it to be effective in a lower dose, which reduces the risk of dependency.
Since 2003, the Delray Center for Healing has provided exceptional psychiatric and therapeutic care for mental health, eating, and substance use disorders. To learn more about our philosophy and treatment approach, download our free e-book, “Psychiatry Redefined,” written by our founder and medical director, Raul J. Rodriguez, MD.