Esketamine as Treatment for Major Depressive Disorder


J. John Mann, MD, compares esketamine nasal spray to intravenous administration and explains the drawbacks of the newly approved treatment method for MDD.

This past month, the US Food and Drug Administration (FDA) approved esketamine nasal spray (Spravato) for treatment of patients with major depressive disorder and acute suicidal ideation.

In a recent interview with HCPLive®, J. John Mann MD, Professor of Translational Neuroscience, Columbia University, talked about how the drug fits into the overall narrative of treatment for depressive symptoms.

“This was done by Janssen Pharmaceuticals, which was good thing. In order to make it financially viable for themselves, they had to come up with a new formulation—a new way of delivering [ketamine]. So, they came up with a nasal spray, which doesn’t involve an IV.”

However, he noted, that the nasal spray’s use makes no difference for the patient—when compared to the 40-minute intravenous method—for 3 major reasons.

First, he explained that patients using esketamine still have to use it in a clinical setting under supervision.

Also, the nasal spray method fails to deliver the drug slowly, reliably, and uniformly. As a result, the patient would have to be taught proper use of the spray.

And finally, Mann added, the faster delivery within the shorter timespan means that higher concentrations of spray would have to be administered to the patient, thus producing more side effects.

Despite acknowledging the pros and cons of esketamine, he nonetheless considered its development and recent indication approval to be a breakthrough. 

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