Ketamine-like spray being examined as treatment for depression

Esketamine has already been approved in the US and trials show it can relieve symptoms within hours

Guidance on a drug derived from ketamine which is seen as a potential treatment for depression is undergoing a second public consultation.

Esketamine is applied as a nasal spray to treat severe depression in patients who have not responded well to traditional antidepressants.

The National Institute for Health and Care Excellence (Nice) has launched a second public consultation on its draft guidance which does not recommend the nasal spray medicine for treatment-resistant depression.

Esketamine, also called Spravato, made by Janssen, is being considered by Nice for treating depression in adults who have not responded to at least two different antidepressants.

Evidence from clinical trials suggests esketamine is more effective than placebo but it is unclear how effective it is because of the way the trials were carried out.

The committee concluded that the estimates for esketamine are much higher than what Nice normally considers a cost-effective use of NHS resources.

Nice said a second consultation is required because comments from the first consultation suggested esketamine may be used in the NHS for patients with more severe depression than people in the trials.

Meindert Boysen, deputy chief executive and director of the centre for health technology evaluation at Nice, said: "There is a clear need for effective alternative treatment options for people with treatment-resistant depression.

"Our independent committee very much recognises the priority of addressing mental health challenges for the NHS.

"However, the introduction of esketamine into clinical practice in the NHS will be complex because the structure and delivery of services would need to be changed.

"The committee is not confident that the impact of these changes has been captured adequately, and would like to understand better what the consequences are of patients having repeated courses of esketamine.

"There is also uncertainty about whether improvement in symptoms and quality of life can be sustained and we would like to hear from stakeholders about this."

PA