NHS watchdog rejects a ketamine-like nasal spray as an antidepressant

NHS watchdog rejects use of snortable antidepressant that contains ketamine-like drug

• Drug was rejected for NHS due to concerns over cost and clinical uncertainties
• Esketamine is already approved for use in the US and EU and can work in hours 
• It is prescribed to people who don’t respond to approved oral antidepressants 
• Watchdog admits there is an unmet need for Brits with drug-resistant depression

Spravato, made by Covid jab maker Janssen, has been rejected for use as antidepressant on the NHS

A nasal spray treatment for depression derived from the illegal party drug ketamine has been rejected for use on the NHS.

Esketamine is said to work by changing brain chemicals responsible for mood, combatting feelings of depression in a matter of hours. 

It is a chemical cousin of ketamine, which itself was first developed as a horse tranquiliser.

Esketamine is made by Covid vaccine maker Janssen under the brand name Spravato and reportedly costs about £10,000 per course of treatment.

The spray is already approved for use in the US and EU where medics say its fast-acting nature can help save lives. 

Traditional anti-depressants can take weeks to work.

But today the National Institute for Health and Care Excellence (NICE) rejected its use on the NHS as an antidepressant for the third time.

NICE said it was concerned about the lack of evidence it would keep depression at bay once a patient stopped taking the drug – and it is too costly.

Esketamine, is a chemical cousin to ketamine, which has been used as party drug since the 2000s. Recent studies on ketamine have also suggested it could help treat depression

The watchdog said further research needed be conducted to address these uncertainties. 

Mental health charities and drug’s manufacturer said they were deeply disappointed with the decision.

FROM PARTY DRUG TO BIPOLAR TREATMENT: EVERYTHING YOU NEED TO KNOW ABOUT KETAMINE 

Ketamine is a powerful general anaesthetic that is used to stop humans and animals experiencing pain during operations.

It started being used as a party drug in the late 2000s, with people taking it before raves for a more intense experience. 

What are the side effects? 

Ketamine causes a loss of feeling and paralysis of the muscles.

It can also lead to people experiencing a distortion of reality, which many call entering the ‘k-hole’.

This is when people believe they have spoken to God or a higher power, which can lead to addiction as they crave that experience.

Ketamine may also cause people to feel incapable of moving, experience hallucinations or lead to panic attacks, confusion and memory loss.

Regular users can seriously damage their bladders, which may need to be surgically removed.

Other risks include a raised heart rate and blood pressure.

Paralysis of the muscles can leave people vulnerable to hurting themselves, while not feeling pain properly can cause them to underestimate any damage. 

Many claim ketamine withdrawal is worse than any other drug, with some feeling so depressed they contemplate suicide. 

If you are having suicidal thoughts, contact the Samaritans here.

How is it taken and what is the law around it? 

For medical use ketamine is liquid but the ‘street’ drug is normally a grainy, white powder, with one gram costing around £20.

As a class B drug in the UK, possession of ketamine can result in people facing up to five years in jail, while supplying it could mean up to 14 years in prison.

Both cases may result in people facing an unlimited fine.  

Source: Talk to Frank

Under the proposal considered by NICE, esketamine would have been offered to adults with severe depression who had not responded to at least two different antidepressants. 

People would have had to go to hospital to get the drug and be supervised by a healthcare professional as they took it.

In its rejection, NICE acknowledged that there was an unmet need for people who have treatment-resistant depression on the NHS. 

About 3 per cent of the British population is believed to suffer from depression, with an estimated 6,000 Britons and 48,000 Americans dying by suicide each year.

Attempted suicides thought to be 10 to 20 times higher than these figures.

Amanda Cunnington, Janssen’s senior director of patient access, said they were ‘deeply disappointed’ by the rejection and were considering an appeal.

‘In treatment-resistant major depressive disorder, there continues to be systemic issues in introducing innovative treatment options on the NHS, which we have tried to overcome,’ she said.

‘We remain steadfast in collaborating with stakeholders and are considering all options including an appeal, to enable access to this important treatment for people living with the condition.’

Marjorie Wallace, chief executive of mental health charity SANE also said the rejection was a ‘huge disappointment’ and would prevent ‘desperate’ patients from getting treatment. 

‘We have little in our armoury to combat treatment-resistant major depressive disorder and the real shame is that NICE are rejecting one of the very few innovations in treating this condition,’ she said.

There have been no major pharmaceutical innovations for depression since the launch of Prozac and related antidepressants in the late 1980s.

Those drugs target the feel-good brain chemical serotonin, and can take weeks or months to kick in.

Esketamine instead works by targeting a chemical called glutamate that is thought to restore brain connections, helping relieve depression, and can work in four to five hours. 

The drug is made from a part of the ketamine molecule, which has been used for decades as a powerful anesthetic to prepare patients for surgery. 

Ketamine has also been used illegally as a party drug since the late 2000s with people taking it before raves as users can experience a distortion of reality and loss of feeling. 

But in February this year French researchers said it could also alleviate suicidal thoughts within days.

Doctors tested the therapy on 160 patients who were admitted to hospital because of their severe suicidal thoughts. 

Almost two-thirds of the participants on ketamine were no longer suicidal after three days. For comparison, the figure was slightly less than a third among patients on a placebo. 

NICE first rejected a submission in January 2020, and then a second time in September that year.

These rejections were also based on concerns over the cost of the treatment.  

Current NHS practice for helping people with treatment-resistant depression is to provide oral antidepressants and switching to a second drug if symptoms do not improve. This treatment can also be combined with psychological therapy.

• For confidential support call the Samaritans on 116123 or visit a local Samaritans branch, or click here for details

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