What is esketamine? What you need to know about the new depression medication – Rolling Stone

Last week, the FDA announced that it had officially approved Spravato, a branded nasal spray containing esketamine, a chemical cousin of ketamine, to treat depression. The drug has been hailed by many as a game changer because it has proven to be an effective treatment for people suffering from depression related to resistance to treatment, or about 30% of all people with depression. But how effective is it in curing the disease and when could it become a viable long-term solution for the 16.2 million adults with depression? Here is what you need to know.

What is esketamine and how does it work in the treatment of depression?
As has been widely reported, esketamine is a chemical cousin of ketamine, the drug best known as anesthetic in high doses, as well as the club, the special drug K.

"Esketamine is essentially ketamine," says Dr. Dan Iosifescu, an associate professor of psychiatry at NYU Langone Health, specializing in the treatment of people suffering from treatment-resistant depression. "Ketamine is a combination of esketamine and r-ketamine … for all practical purposes, there may be slight differences, but it's the same molecule, but packaged differently. 99.9% of all you say about ketamine is what you would say about esketamine. "did it.)

As a treatment for depression, the drug is different from other more common antidepressants, such as Prozac and Zoloft, because it works through a different mechanism in the brain. While other antidepressants modulate a group of chemicals in the brain called monoamines, esketamine targets glutamate, which is found in abundance in the brains of people with depression.

According to Iosifescu, the fact that it works in a completely new way means that it could be effective for about 30% of depressed people who do not respond to traditional antidepressants (the TRDs are defined as people who have taken at least two antidepressants at least six at eight weeks and at the appropriate dose, no effect.)

Iosifescu believes that the effect of esketamine is much faster than that of traditional antidepressants: "not less than an hour" after the administration of a dose, this drug is particularly promising for people with major depressive disorder and may even have thoughts of self-harm. In fact, many studies have highlighted its potential benefits as a drug to administer to a person admitted to an emergency room with suicide ideas.

"You are talking about someone who waited a few months, who finally decided to start something, who took another few months to find no profit, or someone who felt miserable? for more than nine months and you can imagine its impact on life, his family, etc. Iosifescu says. "So it is very helpful to have a method to stop this process and even if it is not a cure but only something helps dramatically and improves things.

Are there any disadvantages to taking esketamine for depression?
Basically, there is a big one: we do not know if it is appropriate to recommend long-term use. We know that esketamine is effective in treating depression and that it works quickly – but we do not know if it's a viable long-term solution because it There are adverse health effects from taking large amounts of this medicine over a long period of time. period of time.

"I think the most important thing is, well, are people supposed to take ketamine forever if it suits them and nothing else works? And we now know that too much ketamine can cause brain damage, "says Iosifescu.

To be honest, these data come from two sources, none of which can be fully applicable to its use as a treatment for depression: brain studies of people who consume ketamine (which usually take much higher doses and do not do not take pure ketamine.) and brain studies in mice and rodents given ketamine for a long time. But such studies have somewhat daunting implications for the long-term use of ketamine, with side effects such as bladder toxicity, cognitive problems and, in the case of mice, brain damage.

"The fact is that there may be a level at which too much ketamine is too much. And we do not know this level, "says Iosifescu. And since the FDA has recommended ketamine only twice a week for four weeks under the supervision of a doctor, it is unclear if this could cause health problems. In addition, the procedure is expensive (the treatment of a month ranges from $ 4,720 to $ 6,785) and takes time, as patients should receive Spravato only under the supervision of a physician. That's why Iosifescu hopes that the researchers will develop oral tablets that can be taken at home and that do not have the disadvantages of esketamine, but that may work in a similar way brain.

At the end of the day, most mental health experts seem to believe that esketamine-related research for people with treatment-resistant depression (particularly acute short-term and acute) is a sufficient motive. to celebrate – but with a slight warning.

"I hope and hope that the field will be able to find an oral treatment that would not have the disadvantages of ketamine and that could be used in the long run," Iosifescu said. It is clear that ketamine is effective for depressed people: "Now the question is, what do you do after it works? "