Esketamine nasal spray treats depression
A new way of treating the most severe form of depression is now available in the UK. Esketamine is a powerful drug delivered as a nasal spray (under the brand name Spravato). Originally licensed in the UK in late 2019, it is now starting to become available privately.
Depression is estimated to affect 3% of the population in the UK in any given week. The total number of people with common mental health problems is reported to have increased 20% between 1993 and 2014. Reported cases of self-harm and suicidal thoughts are increasing at an alarming pace, year on year.
Depression can mean just being in low spirits, but sometimes the severity and duration of symptoms are much worse. It can last for months and can also be life-threatening. It’s a big problem for patients, families and employers.
Treatment resistant depression
Up to a third of patients have a type of depression which remains severe despite attempts to treat it (usually with drugs and talking therapies). A diagnosis of treatment-resistant depression has historically suggested there were few treatment options left available.
Esketamine offers some hope to those patients, their families and the wider community. It originally showed benefits to patients in 2019 when a clinical trial demonstrated it was safe and effective. The study was double-blind, randomised, run across multiple centres and actively controlled, meaning the results could be deemed fairly robust.
The trial showed that patients treated with Esketamine alongside antidepressants showed a significant reduction in severity of symptoms, compared with patients taking solely antidepressants.
A cautious introduction
It has taken a long time for the drug to become available because it has the potential to be abused or misused. It is a Schedule 3 Controlled Substance and can only be prescribed in limited circumstances. That means that usage can only be within strictly designed clinical protocols, which can take time to be developed, reviewed and approved.
Although it shows marked benefits for patients, sadly the treatment is not readily available on the NHS. This is because the National Institute for Clinical Excellence (NICE) currently deems that the cost of the drug (reported to be £10,554 per course), combined with the costs of changes in clinical practice and structures necessary to deliver the service, means that it is too expensive to consider for widespread use.
Limited access privately
Currently the Nightingale Hospital in London, a specialist independent hospital, is the only private hospital in the UK to provide access to the therapy. Private medical insurers are reported to be reviewing applications to fund the treatment on a case-by-case basis.
Patients can self-refer themselves to the Nightingale Hospital for Esketamine treatment. Additionally, GPs and other health professionals can also refer patients. It can be self-funded, if treatment is approved by the clinical team at the hospital. Patients need to be under the care of a Nightingale Hospital consultant psychiatrist for the duration of treatment.
Dr Christopher Muller-Pollard MBBS BSc MRCS MRCPsych who leads the service at The Nightingale says “I clearly remember when Prozac was introduced as a treatment in 1982 and given the large number of people who do not respond to other antidepressants, it is great news that this safe and effective treatment is now available for patients”.
Although the drug has twice been rejected for approval by NICE a third assessment is currently awaiting a decision. If the manufacturer agrees to reduce the price, it is possible the drug will become much more widely available.
Wider access to the treatment would be of potentially large benefit to the thousands of people who suffer with depression every week, as well as their families, friends and employers.
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