Nasal spray similar to ketamine to be added to PBS for treatment-resistant depression

The Guardian

27-04-2025

A medication chemically similar to ketamine will be made cheaper to improve the lives of Australians suffering from treatment-resistant depression.
The drug, which comes in the form of a nasal spray, is a chemical cousin of ketamine, used for decades as a powerful anaesthetic before it was adopted as a party drug in underground rave culture.
There have been no major pharmaceutical innovations for depression since the launch of Prozac and related antidepressants in the late 1980s.
Those drugs target the 'feel-good' brain chemical serotonin and can take weeks or months to kick in.
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Spravato, known chemically as esketamine, works differently. It targets a neurotransmitter called glutamate that is thought to restore brain connections that help relieve depression.
When it works, its effect can be felt within a matter of hours, according to Prof Ian Hickie of the University of Sydney. The co-director of Health and Policy at the University of Sydney's Brain and Mind Centre has been working with the drug for a small number of patients under a special access scheme.
But from Thursday, it will be available and affordable for up to 30,000 Australians through the Pharmaceutical Benefits Scheme.
It will also mark the first new type of medicine for major depression to be funded by the government in three decades.
'Most of the drug development we've had in the last three decades has mimicked what had preceded it,' Hickie said. 'This is different ... it targets a different neurochemical system – glutamate – and appears to regulate those brain circuits that regulate mood in a different way.'
Australian trials using the ketamine-like drug have shown significant improvement in about 50% of people who had otherwise been resistant to conventional treatments.
'Not all depression is the same, nor does it have the same chemical explanation in all people,' Hickie said.
'For some people, particularly those who have failed to respond to the conventional serotonin-focused agents, or monoamine-focused agents, this is different and they appear to benefit.'
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Since the drug was approved for use by the Food and Drug Administration in 2019, it has been commonly used in emergency rooms and other urgent care settings across the US.
'Here's something that actually works quickly, not by knocking you out, not by sedating you, but by alleviating that terrible sense of hopelessness and terrible depressiveness and to some degree that sense of suicidality,' Hickie said.
Spravato will be available through the scheme at a cost per dose of $31.60 or $7.70 for pensioners and concession card holders. However, patients will need to incur additional healthcare and administration costs, including supervision by a healthcare professional at a certified treatment centre.
The minister for health and aged care, Mark Butler, said the listing would make the novel drug more affordable and improve the quality of life for thousands of Australians.
Johnson & Johnson's innovative medicine ANZ managing director, Joana De Castro, said the 'long overdue' listing came after four funding submissions and a four-year wait following Therapeutic Goods Administration registration.
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