A nasal spray derived from ketamine is being used to address treatment-resistant depression

The treatment will be more accessible for up to 30,000 Australians

A drug derived from ketamine will be added to the PBS, helping tens of thousands of Australians struggling with depression to access treatment.

While many conversations surrounding ketamine in the last few years have mainly revolved around its illicit use as a party drug, trials have been ongoing around the world looking into the substance’s role in improving mental health. 

Originally developed as an anaesthetic, ketamine’s usefulness in treating conditions including depression has been the focus of many research papers over the years. 

Now, a medication similar to the drug will be made cheaper for Australians with treatment-resistant depression.

What is esketamine?

A chemical cousin of ketamine, esketamine works by targeting a neurotransmitter called glutamate, which may restore brain connections that help relieve depression symptoms.

Professor Ian Hickie, co-director of Health and Policy at the University of Sydney’s Brain and Mind Centre, highlighted that esketamine works by targeting glutamate, which may help regulate brain circuits related to mood.

He said the drug “works quickly, not by knocking you out, not by sedating you, but by alleviating that terrible sense of hopelessness and terrible depressiveness and to some degree that sense of suicidality”.

Sold under the brand name Spravato, the treatment has been approved for use in Australia by the Therapeutic Goods Administration (TGA) and has been shown to be effective in treating treatment-resistant depression. Image: iStock

According to Mayo Clinic, ‘this medicine may cause prolonged drowsiness, loss of consciousness, mental changes (eg, confusion about identity, place, and time, feeling of unreality, sense of detachment from self or body), or high blood pressure. Your doctor will check for these effects for at least 2 hours after each treatment session.’

Sold under the brand name Spravato, the treatment has been approved for use in Australia by the Therapeutic Goods Administration (TGA) and has been shown to be effective in treating treatment-resistant depression.

Australian clinical trials have shown that many participants with treatment-resistant depression have experienced improvements when treated with SPRAVATO, providing hope for those who have not responded to other treatments.

It is the first new medicine to treat depression funded by the Australian government in over 30 years. Image: iStock

Esketamine nasal spray will soon be subsidised under the Pharmaceutical Benefits Scheme (PBS), making it more affordable for eligible patients starting from May 1.

It is the first new medicine to treat depression funded by the Australian government in over 30 years. 

How esketamine is different from antidepressant drugs

Hickie explained that Spravato works through a different mechanism from traditional antidepressants, targeting the neurotransmitter glutamate to offer a new option for those who have not responded to serotonin-based treatments

Some hours later, many people report that their mood lifts on that day — not as we typically see with antidepressants some weeks later. Image: Pexels

Esketamine targets glutamate instead, making it a potentially useful treatment for people whose symptoms can’t be treated by these drugs.

“Not all depression is the same, nor does it have the same chemical explanation in all people,” Hickie said.

According to Cleveland Clinic, ‘it can take four to eight weeks for antidepressants to work and for your symptoms to ease’. The psychiatrist said patient can feel the effects of esketamine a few hours after receiving a dose. 

“Some hours later, many people report that their mood lifts on that day — not as we typically see with antidepressants some weeks later."

The mental illness is considered treatment-resistant once patients have experienced no improvement after trying several types of treatment.

Who can be prescribed esketamine?

As per Beyond Blue, one in seven Australians lives with depression, and 18 per cent of Australians filled a mental health-related prescription between 2022 and 2023.

The mental illness is considered treatment-resistant once patients have experienced no improvement after trying several types of treatment. 

Those living with treatment-resistant depression will be able to fill a prescription for the nasal spray for a fraction of its current cost from Thursday to be used under medical supervision at a certified treatment centre.

While the PBS subsidy will help make the medication more affordable, patients will still need to pay for the professional clinic visits required for supervised administration of the nasal spray.Image: Getty

Hickie noted that multiple treatments are required over several weeks for patients to experience the full effect of the drug.

So while the PBS subsidy will help make the medication more affordable, patients will still need to pay for the professional clinic visits required for supervised administration of the nasal spray.

"While I think [listing Spravato on the PBS] is a useful step, what I think we really need is for the government to subsidise the treatment cost … which is still a lot for people", Clinical psychiatrist Colleen Loo told the ABC. 

Minister for Health and Aged Care, Mark Butler, said esketamine’s listing on the PBS would make the drug more affordable and improve thousands of Australians quality of life.

In an emergency please call 000

If you or someone you know needs help, phone Lifeline on 13 11 14 or the 24- hour Suicide Call Back Service 1300 659 467.

Mental health professionals are available 24/7 at the beyondblue Support Service – 1300 22 46 36 or via beyondblue.org.au/get-support

Originally published as A nasal spray derived from ketamine is being used to address treatment-resistant depression