Recently, the Food and Drug Administration (FDA) has approved a new ketamine drug for people with major depression.
Different from previous oral drugs and injection drugs, this drug is a nasal spray.
It is called esketamine, derived from ketamine.
Ketamine is an anesthetic commonly used in surgery. Previous research found that it has a surprising antidepressant effect.
Recent clinical studies have shown that treatment with esketamine is effective for patients with treatment-resistant depression.
For example, in one study, about 70% of patients with treatment-resistant depression who were started on an oral depression drug and intranasal esketamine experienced improved symptoms, compared with just over half of the patients who did not receive the medication.
According to Yale scientist John Krystal, MD, and Gerard Sanacora, MD, Ph.D., the new drug works differently than those used previously.
Ketamine could trigger reactions in the cortex that enable brain connections to regrow. It can trigger glutamate production and prompt the brain to form new neural connections.
It makes the brain able to create new pathways and help patients develop more positive thoughts and behaviors. These features make ketamine unique as an antidepressant.
And that is why researchers suggest that ketamine may be most effective when combined with cognitive behavioral therapy (CBT).
CBT helps patients learn more productive attitudes and behaviors.
The new drug allows patients to need a lower dose of esketamine than they do ketamine.
The nasal spray allows the drug to be taken more easily in an outpatient treatment setting.
It is also more accessible for patients than the IV treatments currently required to deliver ketamine.
The researcher warns that the side effects of the new drug include dizziness, a rise in blood pressure, and feelings of detachment or disconnection from reality.
In addition, patients may have a risk of drug addiction.
Currently, the new drug is effective when taken in combination with an oral antidepressant. This means esketamine is not considered a first-line treatment option for depression.
It can be prescribed for people with moderate to severe major depressive disorder who cannot be helped at least two other depression medications.
Future work needs to test the effect of the new drug in a longer time frame and the possible side effects in the long run.
John Krystal is the chief psychiatrist at Yale Medicine and one of the pioneers of ketamine research in the U.S.
Gerard Sanacora is a psychiatrist at Yale Medicine who was also involved in many of the ketamine studies.
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