The FDA has approved a new drug called esketamine—the first new depression treatment in decades.
The drug, created by Janssen Research & Development (a division of Johnson & Johnson), is given in a nasal spray. It was created for people suffering from severe and treatment-resistant depression.
Esketamine might affect millions of Americans who are at risk of suicide due to current therapies’ not being able to help their disease.
The spray will be given only in approved treatment centers, and will be limited to people who have attempted at least two other antidepressant drugs without success.
Patients who get the drug must also be monitored for two hours whenever they use it.
“This is the first new method that has been demonstrated in over 50 years,” says Dr. Sanacora, director of the Depression Program at Yale.
Unlike drugs like Prozac, which was approved in 1987, esketamine targets glutamate, the most populous neurotransmitter in the human brain and nervous system.
“Around 60-80 percent of all brain cells use glutamate as their primary messenger,” Sanacora says.
Previous depression treatments target the monoamine system, which is made of a different group of neurotransmitters: noradrenaline, serotonin and dopamine.
“When we have chronic stress, our neurons get smaller,” says Dr. Scott Russo, director of the Center for Affective Neuroscience at the Icahn Medical School.
“It’s believed that they underperform. Ketamine is known to cause anti-depressant effects by rejuvenating those cells, especially in the prefrontal cortex, a part of the brain responsible for certain cognitive functions like decision-making and judgment.” Esketamine is a newer form of ketamine.
Russo says the blocking of the glutamate receptor using Esketamine may not be completely responsible for the antidepressant effects.
While that mechanism is a catalyst, a series of other “downstream effects” happen after the receptor is blocked. A ripple within that series of events could actually be the thing giving patients relief.
“I want to see more studies done that show the blocking of NMDA receptors is solely responsible for the patients’ relief,” he says. “For example, one piece of research showed that opioid receptors might be involved.”
Russo is overall enthusiastic about the drug’s possibility and approval. “It’s a game changer,” he says. “I have not seen this sort of discovery during my lifetime—I hope this kicks off a chain reaction of new psychiatric drugs.”
Author: Scott Dowdy