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A potentially vital treatment for depression has become more practical with the introduction of a new nasal spray called esketamine – a drug therapy that the South Carolina Medical University has helped research.
"It's probably the most exciting thing I've worked on," said Dr. Robert Malcolm, a MUSC psychiatrist, who led the institution's drug research. This is a breakthrough.
In 2016, the Centers for Disease Control and Prevention reported that more than 8% of Americans suffered from depression over a period of two weeks. In the same year, 11% of high school students in South Carolina reported having experienced at least one major depressive episode, according to the US Department of Health and Human Services.
"Depression is a common disease in South Carolina," said Malcolm.
In recent years, Malcolm has conducted research studies and the new esketamine-based treatment was one of them. With a number of patients responding well to the drug, these people will continue to receive the drug until it is fully marketed, he said.
When the drug will be officially available to the public, it will be recommended to use it when other antidepressants fail or need further improvements.
The drug, which will be marketed as Spravato, has been officially approved by the Food and Drug Administration for the treatment of depression this month and was immediately followed by a string of mixed reviews.
While many experts view the new nasal spray as a breakthrough in the rapid treatment of symptoms of depression in minutes and hours, cost issues and lack of certainty about long-term effects have also introduced skepticism. .
"It's exciting, but we have reservations," said Malcolm.
The innovative treatment is an evolution of a popular infusion therapy and examined in a similar way with an anesthetic called ketamine.
At present, ketamine is also sometimes used as a very fast treatment for the symptoms of depression. Historically, it is a popular anesthetic that does not interfere with the person's ability to breathe during a general anesthesia. Today, it is also used as a pediatric anesthetic.
By the 1990s, Yale University discovered that it was effective and incredibly effective at treating the symptoms of depression. But before that, in the 1970s and 1980s, it was also a popular club drug called "Special K" because of one of its side effects that can be hallucinations. This is where additional monitoring and regulation of ketamine and esketamine, which have similar side effects, comes from.
It is recommended to use both treatments when antidepressants have not been effective. For ketamine treatment, patients should go to a specialized clinic offering intravenous infusion therapy.
Similar to ketamine, esketamine will not be available over-the-counter, even if it's a nasal spray.
"I think people are worried that it could be used as a nasal spray," said Malcolm. "People could take it with them."
Patients will need to be treated in clinics to receive a dose of esketamine. Although a nasal drug of nasal spray ketamine is already prescribed, this specific drug is much milder and slightly different from esketamine recently approved by the FDA.
"This is a great step forward," said Dr. Richard Bowen, owner of the Charleston Ketamine Center, which has done more than 2,000 infusions of anesthetics.
One of the most prominent critics of ketamine has always been the cost, and the new esketamine does not seem to be different. When the average cost of six initial infusions of ketamine is about $ 500 per infusion, an initial one – month treatment for esketamine will likely cost between $ 4,000 and $ 6,000.
Bowen and Malcolm both find that the prices are incredibly unfortunate given the severity of the depression.
"What many people do not realize is that depression is often a terminal illness," said Bowen.
Megan Grace Sanchez, a retired police officer and resident in Mooresville, NC, said the infusion therapy she had received from Bowen had quickly calmed her suicidal thoughts.
When antidepressants did not affect her depression and sometimes worsened her symptoms, she was looking for an alternative. Although initially nervous and skeptical about the use of ketamine, she felt more comfortable after experiencing Bowen's experience with the treatment.
"These six initial treatments have been very positive," she said. "It was the first time I felt optimistic about a treatment in 10 years."
She said that if Bowen recommends the new nasal spray, she will use it gladly.
With esketamine, an FDA-approved treatment, the hope is that more insurers will cover costs for patients. One of the demographics that Malcolm thinks is most beneficial is that of veterans.
In 2016, the Department of Veterans Affairs reported that the suicide rate among South Carolina veterans was much higher than that of non-veterans in the state. According to Malcolm's experience, he discovered that esketamine and ketamine were an effective treatment for immediately attacking thoughts and suicidal tendencies.
He said that it also works where other drugs have failed.
David Thomas, a 76-year-old Army veteran and resident of Greenville, said he had been using ketamine for about eight years. Without treatment, he says, he would certainly be dead.
"Because I was suicidal, I have no doubt about it," he said. "Saved my life, no question in my mind."
In battling issues such as post-traumatic stress disorder, Thomas hopes that esketamine will be a useful alternative to get more help from the Veterans Hospital to meet the costs. Currently, to receive an infusion of ketamine, he often has to pay from his pocket.
"I think it's going to be wonderful," he said.
Although the long-term symptoms of anesthetic and new nasal spray are still being researched and being determined, experts are not denouncing the impact of the drug's approval by the FDA. It is hoped that in the future, the treatment will be cheaper and possibly available even orally.
At this point, Malcolm said he trusted the drug's success.
"We did three studies with the nasal spray," said Malcolm. "We have been working with this compound for a long time."
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