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Ketamine 'shows promise' in treating depression

Trials using nasal spray esketamine showed rapid improvement in depressive symptoms

Mark Gould

Monday, 16 April 2018

Ketamine, the anaesthetic often associated with recreational drug use, has "shown promise" in the rapid treatment of major depression and suicidal thoughts.

A study* in the American Journal of Psychiatry found use of the drug via a nasal spray led to "significant" improvements in depressive symptoms in the first 24 hours.

The Royal College of Psychiatrists said it was a "significant" study that brought the drug "a step closer to being prescribed on the NHS".

The report by researchers from Janssen Research and Development, a Johnson and Johnson company, and Yale School of Medicine, is the first study into ketamine as a treatment for depression that has been done by a drug company.

The trial looked at 68 people at imminent risk of suicide who had been treated with antidepressants as inpatients. Half were given ketamine in the form of esketamine (part of the ketamine molecule) in a nasal spray and half were given a placebo.

The study found those using esketamine had a much greater improvement in depression symptoms at all points over the first four weeks of treatment. However, at 25 days the effects had levelled out.

"These preliminary findings indicate that intranasal esketamine compared with placebo, given in addition to comprehensive standard-of-care treatment, may result in significantly rapid improvement in depressive symptoms, including some measures of suicidal ideation, among depressed patients at imminent risk for suicide," the authors conclude.

The nasal spray is now undergoing phase three trials before it can be licensed for treatment.

There were no reports of esketamine dependence or misuse in the trial, but the authors warn that more research is needed on the potential for abuse of ketamine and say these should be looked at during subsequent trials.

Scientists in the UK are also studying ketamine as a treatment for depression taken intravenously.

Dr James Stone, from the Royal College of Psychiatrists, told the BBC the "interesting" US study confirmed the findings from successful studies into intravenous ketamine.

"The main reason for its significance is because this is being developed by a drug company and it's potentially quite likely that this medication might become available as a treatment available on the NHS for depression."

He said because it was being given as a nasal spray it was "much easier to administer" than intravenous ketamine and was "potentially quicker to give, so it means more people can be dosed at the same time" and you need less equipment.


* Canuso CM, Singh JB, Fedgchin M, et al. Efficacy and Safety of Intranasal Esketamine for the Rapid Reduction of Symptoms of Depression and Suicidality in Patients at Imminent Risk for Suicide: Results of a Double-Blind, Randomized, Placebo-Controlled Study. The American Journal of Psychiatry, published online 16 April 2018. DOI: 10.1176/appi.ajp.2018.1706072

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