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Ketamine-based drug approved for treating severe depression in US

'I just let the drug work. I close my eyes and my mind is amazingly quiet'

Alex Matthews-King

Health Correspondent

Thursday 07 March 2019 11:00 GMT

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Ketamine-based drug approved for treating severe depression in US

A breakthrough treatment based on the recreational drug ketamine has been approved in the US for people with severe depression.

Esketamine is administered as a nasal spray and was approved by the Food and Drug Administration (FDA) this week after trials showing it could relieve depressive symptoms within hours.

This is unlike regular antidepressants, which can take weeks to work leaving sufferers, who may be contemplating suicide, incredibly vulnerable.

“[That speed] is a huge thing because depressed patients are very disabled and suffer enormously,” said Dr John Mann, a psychiatrist and researcher at Columbia University.

Esketamine is the first approved depression treatment for more than 30 years to act on the brain in a unique way, and will be offered to patients who have tried at least two other treatments without success.

World's 10 deadliest street drugs

Show all 10

1/10World's 10 deadliest street drugs

World's 10 deadliest street drugs

Whoonga

Whoonga is a combination of antiretroviral drugs, used to treat HIV, and various cutting agents such as detergents and poisons. The drug is widely available in South Africa due to South Africa’s high rate of HIV sufferers, and is believed to be popular due to how cheap it is when compared to prescribed antiretrovirals. The drug is highly addictive and can cause major health issues such as internal bleeding, stomach ulcers and ultimately death

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World's 10 deadliest street drugs

Scopolamine

Scopolamine is a derivative from the nightshade plant found in the Northern Indian region of South America (Ecuador, Colombia and Venezuela). It is generally found in a refined powder form, but can also be found as a tea. The drug is more often used by criminals due its high toxicity level (one gram is believed to be able to kill up to 20 people) making it a strong poison. However, it is also believed that the drug is blown into the faces of unexpecting victims, later causing them to lose all sense of self-control and becoming incapable of forming memories during the time they are under the influence of the drug. This tactic has reportedly been used by gangs in Colombia where there have been reports of people using scopolamine as way to convince victims to rob their own homes

World's 10 deadliest street drugs

Heroin

Founded in 1874 by C. R. Alder Wright, heroin is one of the world’s oldest drugs. Originally it was prescribed as a strong painkiller used to treat chronic pain and physical trauma. However in 1971 it was made illegal under the Misuse of Drugs Act. Since then it has become one of the most destructive substances in the world, tearing apart communities and destroying families. The side effects of heroin include inflammation of the gums, cold sweats, a weak immune system, muscular weakness and insomnia. It can also damage blood vessels which can later cause gangrene if left untreated

World's 10 deadliest street drugs

Crack cocaine

Crack cocaine first came about in the 1980’s when cocaine became a widespread commodity within the drug trafficking world. Originally cocaine would have attracted a high price tag due to its rarity and difficulty to produce, but once it became more widespread the price dropped significantly. This resulted in drug dealers forming their cocaine into rock like shapes by using baking soda as a way of distilling the powder down into rock form. People were doing this because it allowed for them to sell cocaine at a lower quantity and to a higher number of people. The side effects of crack cocaine include liver, kidney and lung damage, as well as permanent damage to blood vessels, which can often lead to heart attacks, strokes, and ultimately death

World's 10 deadliest street drugs

Crystal meth

Not just famous because of a certain Walter H White, but also because it is one of the most destructive drugs in the world. First developed in 1887, it became widely used during the Second World War when both sides would give it to their troops to keep them awake. It is also believed that the Japanese gave it to their Kamikaze pilots before their suicide missions. After the war crystal meth was prescribed as a diet aid and remained legal until the 1970s. Since then it has fallen into the hands of Mexican gangs and has become a worldwide phenomenon, spreading throughout Europe and Asia. The effects of crystal meth are devastating. In the short-term users will become sleep depraved and anxious, and in the long-term it will cause their flesh to sink, as well as brain damage and damage of the blood vessels

World's 10 deadliest street drugs

AH-7921

AH-7921 is a synthetic opioid that was previously available to legally purchase online from vendors until it became a Class A in January 2015. The drug is believed to have 80% of the potency of morphine, and became known as the ‘legal heroin’. While there has only been one death related to AH-7921 in the UK, it is believed to be highly dangerous and capable of causing respiratory arrest and gangrene

World's 10 deadliest street drugs

Flakka

Flakka is a stimulant with a similar chemical make-up to the amphetamine-like drug found in bath salts. While the drug was originally marketed as a legal high alternative to ecstasy, the effects are significantly different. The user will feel an elevated heart rate, enhanced emotions, and, if enough is digested, strong hallucinations. The drug can cause permanent psychological damage due to it affecting the mood regulating neurons that keep the mind’s serotonin and dopamine in check, as well as possibly causing heart failure

World's 10 deadliest street drugs

Bath salts

Bath salts are a synthetic crystalline drug that is prevalent in the US. While they may sound harmless, they certainly aren’t the sort of salts you drop into a warm bath when having a relaxing night in, they are most similar to mephedrone, and have recently been featured throughout social media due to the ‘zombification’ of its. The name comes from the fact that the drug was originally sold online, and widely disguised as bath salts. The side effects include unusual psychiatric behaviour, psychosis, panic attacks and violent behaviour, as well as the possibility of a heart attack and an elevated body temperature

World's 10 deadliest street drugs

Purple Drank

One of the more unusual drugs around at the moment, purple drank was popularised in 90s hip hop culture, with the likes of Jay Z and Big Moe all mentioning it in their songs. It is a concoction of soda water, sweets and cold medicine, and is drunk due to cold medicines high codeine content, which gives the user a woozy feeling. However it can also cause respiratory issues and heart failure

World's 10 deadliest street drugs

Krokodil

Krokodil is Russia’s secret addiction. It is believed that over one million Russians are addicted to the drug. Users of krokodil are attracted to the drug due to its low price; it is sold at £20 a gram while heroin is sold for £60. However, krokodil is considered more dangerous than heroin because it is often homemade, with ingredients including painkillers, iodine, lighter fluid and industrial cleaning agents. This chemical make-up makes the drug highly dangerous and likely to cause gangrene, and eventually rotting of the flesh

Because of the potential for abuse, esketamine is administered under medical supervision, with patients supervised for two hours afterwards.

“You can feel it coming on, it’s a strong drug,” Robin Prothro, 60, says, describing colours and shapes that drift before her eyes. “I just let the drug work. I close my eyes and my mind is amazingly quiet.”

Because the drug’s effects last much longer than conventional antidepressants, she only needs to attend once every two weeks.

Ms Prothro has been on antidepressants for more than 20 years and enrolled on the Spravato trial as the five different medications she tried previously were ineffective.

Since joining the trial she has been able to return to hobbies which she abandoned years ago, like gardening.

The esketamine molecule is a mirror image of the ketamine molecule – which has a long history of use in medicine as an anaesthetic – but is three times as potent, meaning it can be given at a lower dose.

In the UK some NHS groups offer ketamine-assisted treatment for major depression – but this has to be given as an intravenous infusion, which is more labour intensive than the spray.

It works by targeting glutamate receptors in the brain and promoting new connections between brain cells. However, some groups have warned it acts in a similar way to opioid painkillers which are driving an addiction epidemic in the states.

The drug was developed by Janssen – part of Johnson and Johnson – and is being marketed under the name Spravato.

“There has been a longstanding need for additional effective treatments for treatment-resistant depression, a serious and life-threatening condition,” said Dr Tiffany Farchione, acting director of the Division of Psychiatry Products at the FDA.

“Controlled clinical trials that studied the safety and efficacy of this drug, along with careful review through the FDA’s drug approval process including a robust discussion with our external advisory committees, were important to our decision to approve this treatment.”

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