A new ketamine-type nasal spray treatment for depression is now covered by the pharmaceutical benefits scheme (PBS).
From 1 May Esketamine, sold under the brand name Spravato, can be prescribed to adults with treatment-resistant depression.
This means Australians living with depression that has not been relieved with the use of antidepressant tablets will have more affordable access to this medicine.
Esketamine is a version of the anesthetic drug ketamine and works by increasing glutamate levels in the brain to stimulate and restore message transmission within the brain. The nasal spray is used in conjunction with an oral antidepressant.
According to Johnson & Johnson, it is the first new type of medicine for major depression to be funded by the government in three decades.
The Therapeutic Goods Administration approved Spravato for use in 2021 but only those who could afford to pay the estimated $500-$900 per dose were able to access it.
Now, up to 30,000 Australians are expected to receive Spravato through the PBS at a cost of $31.60, or $7.70 for those with a pensioner or concession card.
Clinical psychologist Dr Rob Schütze, of Curtin University’s School of Population Health and Royal Perth Bently Group, welcomed the news as a significant step for treatment-resistant depression (TRD).
He added that many people did not respond to tradition clinical interventions like CBT, antidepressants and lifestyle interventions.
“Those who don’t respond to two conventional treatments are classified as having treatment resistant depression. Evidence suggests less than 15% of people with TRD recover,” he told Medical Forum.
“There is therefore an urgent need for innovations in how we treat depression and how we individualise these treatments for different people, since not all depression is the same.
“Listing esketamine on the PBS will make it accessible to more people with TRD, although it will be some time before there are enough doctors with the training and facilities to provide this supervised treatment.”
Depression affects one-in-seven Australians and, of those, it is estimated that a third cycle through multiple antidepressant treatments without satisfactory relief and are therefore deemed to have ‘treatment-resistant depression’.
Compared to people with major depressive disorder, those with treatment-resistant depression tend to experience more severe symptoms, significantly longer depressive episodes, suicidal thoughts, an inability to experience joy, and a higher number of depressive episodes during their lifetime.
Spravato is the first medicine specifically for treatment-resistant depression to be accessible as part of the PBS.
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Dr Schütze said it will be important to integrate eskatamine into a more comprehensive treatment plan, rather than relying on the medicine alone.
“For example, it should ideally be combined with lifestyle interventions focusing on exercise, sleep and diet in order to get lasting benefits. For those who can access a psychologist, combing ketamine with psychotherapy will also give it the best chance of relieving depression in the long term,” he added.
“Esketamine should be used to provide a ‘therapeutic window’ that allows patients to engage with these other evidence-supported behavioural treatments, rather than as a singular curative treatment.
“By giving people a rapid lift in their mood, esketmaine may help people to better engage with these behavioural treatments, which can otherwise be difficult to adhere to.”
Treatment using this type of medicine is only available through certified centres that have the capabilities to safely administer the treatment and monitor patient safety.
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Under clinical supervision, the medicine is administered via nasal spray, allowing it to be absorbed by the lining of the nasal passages and move into the blood stream.
This is done twice-a-week for the first month, weekly for the next month, and then weekly or fortnightly until depressive symptoms improve, at which point it is advised treatment should continue for at least six months.
Medication side effects can include dizziness, nausea, disassociation, numbness, increased blood pressure and headache.
To be eligible for a prescription a patient will need a diagnosis of treatment-resistant depression.
Prescribers will need to pay particular attention to harms associated with drug interactions, Dr Schütze said.
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