The Food and Drug Administration on Tuesday approved esketamine, the first major depression treatment to hit the U.S. market in decades and a new option for patients who haven’t responded to existing therapies.

Esketamine — developed by Johnson & Johnson (JNJ) and delivered as a nasal spray — was tested in combination with oral antidepressants in patients with what’s known as treatment-resistant depression. The drug is related to ketamine, a common anesthetic that’s sometimes misused recreationally. Many experts have hailed esketamine as a critical option for patients in dire need of new treatments — particularly because it might work faster than existing antidepressants.

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  • Ketamine is a NMDA antagonist. Apparently Spravato is also. How is this modifying neurophysiological understanding of depression.

  • Interesting. Ketamine has been kicking around integrative medicine for years. Perhaps we should call it leading edge medicine… Nasal spray seems a good route for administration. I do wish a provoked heavy metals test and tox screen was part of every non-emergency psych referral and prescription. Also helpful is screening for genes that impair methylation pathways, and prescribing targeted nutritional supplements based on metabolic pathways, as is now being done in functional psychiatry.

    I also wish first-line prescriptions might include such things as nature walks and ocean swimming, which have multiple routes of administration: nasal, oral, eyes, ears, skin, and exercise. For resistant cases, also consider vibrational therapies, on the spectrum from gong and sound therapy to Transcranial Magnetic Stimulation (mentioned by Larry below) to brain MRIs, which were tested at McLean Hospital for bipolar disorder.

    Ketamine expands the options for resistant cases, which is a good thing. Does it change brain chemistry over a short term prescription, or is it a lifetime Rx? The benefit of some of these other therapies is that it helps reboot the brain, although targeted supplements are typically needed on an ongoing basis.

  • Uh, this is not the first major depression treatment in decades. Do a little research on TMS therapy (Transcranial Magnetic Stimulation). With a better than 70% response rate and none of the side effects of medication, it is a far superior treatment option for med resistant patients. And oh yeah, it’s been approved by the FDA since 2008 and is covered by insurance.

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