Singapore has begun using a nasal spray version of ketamine to treat patients with major depressive disorder who don’t respond to other forms of treatment.
The country’s drug authority, the Health Sciences Authority (HSA), approved esketamine, Johnson & Johnson’s version of ketamine sold under the brand name Spravato, on Oct. 27, 2020. HSA approved the therapy for treatment-resistant major depressive disorder in combination with an oral antidepressant such as an SSRI or SNRI. The modified version of ketamine has now been administered to two patients in Singapore.
Spravato was approved by the U.S. Food and Drug Administration (FDA) in Aug. 3, 2020, to treat people with major depressive disorder with acute suicidal ideation or behavior. The medication is the first and only antidepressant shown to reduce depressive symptoms with the first dose within 24 hours—much faster than the 2- to 4-weeks it takes antidepressants currently on the market.
Ketamine is a dissociative anesthetic that has been used for decades in medical and emergency settings for sedation and pain relief. The medication can have psychedelic effects and has been used as a party drug. As a result, the Drug Enforcement Administration has classified it as a Schedule III drug under the Controlled Substances Act.
Unlike esketamine, ketamine is not approved to treat depression. However, it is prescribed off-label to treat depression, which enables ketamine infusion clinics to operate in certain states.
“Many people who live with depression know all too well the feeling of desperation. If that major depression progresses to active suicidal thoughts, it’s crushing, and they need options to help change the trajectory of their acute depressive episode,” said Theresa Nguyen, Chief Program Officer, Mental Health America. “Traditional oral antidepressants need weeks or more to take effect, so the availability of a medicine that can begin providing relief within a day is potentially life changing.”
