PBS listing for ketamine nasal spray to fight depression

The federal government has bankrolled the use of an artificial ketamine nasal spray to combat treatment-resistant depression, providing treatment for those with ‘little hope’.

Ketamine as a nasal spray for treatment resistant severe depression was approved in 2021 by the Therapeutic Goods Administration, with a Pharmaceutical Benefits Scheme subsidy set to take effect from May 1. Picture: Supplied

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The federal government has bankrolled the use of an artificial ketamine nasal spray to combat treatment-resistant depression, further opening the door for dissociative and psychedelic mental health treatments.

The esketamine nasal spray – sold as Spravato by Johnson & Johnson – is the first new class of depression drug subsidised by the Pharmaceutical Benefits Scheme in more than 30 years. Up to 30,000 patients are expected to be eligible to use it. It was first ­approved for use in Australia by the Therapeutic Goods Administration in 2021.

Eligible users will only have temporary access to the treatment after failing to respond to at least two other antidepressants. Unlike traditional antidepressants which raise serotonin levels, esketamine targets glutamate receptors in the brain to improve neural connections involved with mood and thought processes.

Of the 10-14 per cent of Australians who experience depression, a third are resistant to antidepressants and often face more ­severe symptoms such as frequent depressive episodes and suicidal ideation.

Psychiatrist Ian Hickie. Picture: Supplied

Sydney University psychiatrist Ian Hickie said the new form of treatment had been found to positively impact this treatment-­resistant group.

Rather than making the nasal spray available at pharmacies, ­patients must go to medical clinics where it can be administered by a professional every one to two weeks over three months.

“This is not something where you’re going to pop down to your GP and get a squirt up your nose, for a whole number of reasons including safety and complications,” Professor Hickie said.

“It’s for acute treatment. That’s the first challenge, it’s getting people out of the hole they’re in.

“Depression of this nature ­affects every aspect of a person’s life and can make it seem as though life is not worth living … When multiple treatment options have not delivered relief, that feeling can be compounded, leaving people with little hope.”

Professor Hickie argued the stringent measures limiting misuse of esketamine also impinged on access. Even though the treatment itself is subsidised, patients still have to pay for the clinic ­appointments where it is administered. “People with treatment-resistant depression have complex and often urgent mental healthcare needs. Affordable access to treatment is essential if we are to help them out of what is often a dark, deep and dangerous hole,” he said. “This has to be done in a specialist medical clinic under medical supervision and involves getting to a medical specialist, so there are out-of-pocket costs to that.

“The federal government has stepped up in terms of putting this on the PBS, but we need state government services to step up in providing access.”

Esketamine is one of a number of emerging drug treatments for mental health conditions reliant on the restricted use of prohibited recreational drugs.

The Department of Veteran Affairs is set to fund MDMA and ­psilocybin-assisted therapies for veterans with post-traumatic stress disorder and treatment-­resistant depression, while ­cannabis prescriptions for chronic pain and anxiety have swelled in recent years.

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