People used to take “Special K” when hitting dance clubs to get into a trance, the music and lights adding to the high. Now, the base of “Special K” – ketamine – is being used to treat certain types of depression. It is the first new depression treatment in three decades. Ketamine is not new. It was developed in 1962 as a sedative to help activate and maintain anesthesia. It’s also been used to treat chronic pain, but it’s gotten the most publicity for its use as a party drug. In 2005, researchers looked into how it might affect depression. After giving people doses, the patients felt relief within two hours. Within 24 hours, 50-75% of study participants felt significantly better. The effects of most antidepressants take weeks and when someone is in a mental health crisis, that can mean life or death.
In March, the FDA approved the world’s first prescription ketamine treatment for depression from Johnson and Johnson. The medication is called “Spravato” or “esketamine,” and it has an unusual form: a nasal spray. That’s not the only thing about it that’s unorthodox. It must be administered by a doctor in an office, so the doctor can see if it has any adverse effects. Patients get the treatment twice a week for a month, then every week, and then every other week. They must already be on an oral antidepressant. Because it’s so new, the FDA only approved it for people with treatment-resistant depression. It isn’t cheap, either: depending on the dose, it could cost almost $900 per session.
Like all antidepressants, Spravato comes with a black box warning. That means it could cause suicidal thoughts, and because the medication works so quickly, that could be dangerous. That’s why it needs to be administered by a doctor. For those it does help, however, that almost instant relief could be a life-saver.