Nasal spray for depression and suicide

A nasal spray to help manage major depression and potentially reduce suicide risk could be available soon.

Janssen Pharmaceuticals has made a marketing application for esketamine spray for treatment-resistant depression (TRD) in adults with depression that have not responded to at least two different treatments with antidepressants. The hope is that the drug could offer rapidly-acting support for people at imminent risk of suicide.

Esketamine is a glutamate-receptor modulator and the S-enantiomer of ketamine, which has a higher affinity for the NMDA receptor than the R-enantiomer. If approved it would be the first novel antidepressant to be launched for at least two decades

Janssen presented data earlier this year showing that continuing treatment with esketamine plus an oral antidepressant ‘showed clinically meaningful and statistically significant superiority’ to treatment with an oral antidepressant plus placebo nasal spray in delaying time to relapse of symptoms of depression.

Patients in remission treated with esketamine plus an oral antidepressant reduced their risk of relapse by 51% compared to patients receiving an oral antidepressant plus placebo nasal spray.

In one early study, the authors reported that intranasal esketamine appears to be effective for patients with treatment-resistant depression with a rapid onset and is generally well tolerated.

The parent drug, ketamine is currently used as an anaesthetic and is given intravenously or by intramuscular injection. It is also a drug of abuse and some concerns have already been raised over the new nasal spray version’s abuse potential.

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