Ketamine Nasal spray
Spravato (Janssen Pharmaceuticals, Inc.) is the first Ketamine nasal spray formulation approved by the FDA for use in treatment resistant-depression In the USA. Spravato contains esketamine.
What Is Esketamine?
Esketamine, the drug used in Spravato is an 'enantiomer' of Ketamine, meaning it has the same chemical formula, however, it is a ‘mirror image’ of Ketamine. To put it in simple terms, if Ketamine is represented by our right hand, Esketamine would be our left hand.
Esketamine, like Ketamine, is a general anesthetic with similar uses for both drugs. In terms of depression treatment, both drugs are fast-acting with Esketamine being more potent. Because of the potential for abuse, Esketamine is only available in the US through special distribution centres and not directly to patients.
How Esketamine treats depression (video)
How likely that we will see Ketamine nasal spray in the UK
With a price tag of £3500-£5200 per month of initial treatment, it is highly unlikely that NICE approves Ketamine nasal spray for the treatment of depression in the UK. According to NICE guidelines, moderate to severe depression is managed with an antidepressant drug.
A selective serotonin reuptake inhibitor (SSRI) is the preferred, first-line treatment of depression. Citalopram and sertraline (SSRIs) are the most commonly used antidepressants in the UK. Read more about the most commonly prescribed drugs in the UK in my separate post.
Is Ketamine available for the treatment of depression in the UK?
Ketamine is available in the UK for the treatment of depression which has not responded to other treatments. Oxford Health NHS foundation trust provides a private service with the treatment of Ketamine, only for patients referred to the service by their GP or psychiatrist.
The low dose of Ketamine is infused directly into your body over 40 minutes. The initial treatment of 3 infusions costs £215 per infusion.
Ketamine is currently classified as a class B controlled drug in the UK and carries penalties for possession, prison sentence, and/or an unlimited fine.
The popularity of Ketamine as the drug of abuse has fallen in recent years with estimated 94000 adults who used it in 2016 (DrugWise, 2016).