Point of view: Esketamine should improve treatments for depression, but we do not know enough about long-term effects



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With fanfare, a new antidepressant entered the US market in March [2019], the first fundamentally new drug against depression for decades. Based on the anesthetic ketamine, the drug – called Spravato – is intended to quickly help people with severe depression, taking effect in hours or days instead of weeks taken by conventional antidepressants. But despite all this hubbub, big questions remained unanswered about the drug.

Some psychiatrists are worried that the drug has been approved by the US Food and Drug Administration on the basis of lean data, by standards lower than those required for previous antidepressants. For example, one does not know what happens when someone stops taking the drug, as well as its long-term effects.

MRI scans of people who have abused ketamine for a long time reveal brain damage (although other factors may be responsible for these lesions). And animal studies also show brain damage induced by ketamine. But little is known about the long-term effects of esketamine on people with severe depression. "If you take ketamine for too long – and you do not really know what it's too long – it's going to be a problem," [psychiatrist Dan] Iosifescu said.

Read the full original message: New ketamine antidepressant raises hope and questions

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