A ketamine-based nasal spray may be superior to conventional medication for adults with treatment-resistant depression, according to recent studies.
Per significant clinical research, those who used the spray and other antidepressants had a higher chance of seeing a lasting remission of their symptoms than those who used an antipsychotic.
For many years, people have taken ketamine as a sedative and a recreational substance with dissociative properties. It has lately gained popularity as a potential depression therapy.
Although this is regarded as an off-label usage of the medication, people who take ketamine for depression frequently obtain modest dosages of it through IV infusions given at specialized clinics.
However, in 2019, the Food and Drug Administration formally authorized Spravato, a nasal spray created by Johnson & Johnson. Esketamine, a chemical relative to ketamine, is used in this spray and is one of the two molecules that make up ketamine.
For those with severe depression who have not responded to conventional medications, Spravato was first authorized. Based on data demonstrating that it might effectively decrease ideation, the FDA approved it in 2020 for depressed individuals with acute suicidal thoughts or actions.
Ketamine should be taken in addition to other traditional antidepressants.
Additionally, the spray plus these medications outperformed the other drugs with a placebo spray in the critical studies that approved it.
However, other medicines have traditionally been used to treat those with severe depression, and it is yet unclear how ketamine-based therapies stack up against these treatments.
The antipsychotic quetiapine, frequently marketed as Seroquel, is one of these alternatives. The ESCAPE-TRD study, a follow-up to J&J's clinical trials of Spravato, directly compared the spray to quetiapine. The trial's early findings were made public in November of last year, and the data was formally published in the New England Journal of Medicine.
Findings from the study:
More than 650 individuals with treatment-resistant depression participated in the trial. They were randomly assigned to receive either quetiapine or the nasal spray, in addition to conventional antidepressants.
Following a standard scoring system, after week eight, 28% of patients using the spray had their depression under control, as opposed to 18% of those using quetiapine.
The remission rate remained greater in those on esketamine up to 32 weeks later, with 55% versus 37%, respectively. This was the study's primary goal.
Additionally, a more significant number of individuals—22% and 14%—did not suffer any recurrence of their symptoms throughout the 32 weeks.
Allan Young, the study's author and the head of the Center for Affective Disorders at King's College London, thinks that ketamine ought to be regarded as a first-line therapy for treatment-resistant depression in light of these findings.
"There is an argument for using ketamine first if we can identify the characteristics of those who would respond well," he told Gizmodo in an email.
"There is an argument for using ketamine first if we can identify the characteristics of those who would respond well."-Young via email to Gizmodo
He also points out that only a small percentage of subjects responded fully to esketamine. Therefore, even while researchers are optimistic about the potential of this medication and similar ones, we still need various therapy options to assist everyone who suffers from depression effectively.
- The New England Journal of Medicine. Esketamine Nasal Spray versus Quetiapine for Treatment-Resistant Depression.
- FDA. FDA approves new nasal spray medication for treatment-resistant depression; available only at a certified doctor’s office or clinic.
- Gizmodo, Ketamine Nasal Spray Better Than Standard Drugs in Major Depression Trial.