UAE psychiatrists divided on 'breakthrough' ketamine-based depression drug

Fast-acting esketamine is due to become available in March

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A fast-acting ketamine-based nasal spray could offer hope to thousands of people with depression in the UAE when it is introduced in March.

Esketamine is described by doctors as a "fast-acting" medicine that must be used in a controlled environment due to its psychoactive properties.

Although the treatment will offer another weapon for doctors against depression, psychiatrists are divided on how effective it may be.

With more people seeking help as mental health stigma fades, psychiatrists hope the Spravato treatment will throw a lifeline to those who have experienced little improvement from established drugs like Prozac.

Unlike conventional antidepressants which can take three to four weeks to show improvement in depressive symptoms, this drug can produce positive changes within hours

Other medics have said the drug could lead to addiction and abuse, though it is expected to be strictly controlled.

Ketamine's status as a party drug often referred to as "horse transquiliser" has caused reticence and confusion about the treatment.

"The reservations have included a potential for abuse and dependence, as well as the cost factor," said Dr Saeed Islam, a consultant psychiatrist and medical director at Priory's Middle East clinic.

"Unlike conventional antidepressants which can take three to four weeks to show improvement in depressive symptoms, this drug can produce positive changes within hours.

“The cost is still an issue and it will remain a treatment option for a few patients only.”

Other risks listed on medical licensing documents include a chance of transient perception disorders, disturbances in consciousness, cystitis and increases in blood pressure.

A group of 12 psychiatrists in the UK expressed their reservations to regulators, claiming short-term improvements similar to recreational drugs should not have been used as a basis to approve the medication as a treatment for depression.

Doctors described the drug as a "breakthrough" when it was announced that Spravato would be made available in the UAE earlier this year.

While traditional antidepressants work by boosting serotonin – a neurotransmitter thought to have a good influence on mood, emotion and sleep – in the brain, Spravato is the first drug in decades to target a new brain pathway: glutamate.

Glutamate is a neurotransmitter that plays an important role in learning and memory and is considered essential for normal brain function.

But treatment will not be cheap and is expected to be priced at about $600 (Dh2,200) per session.

In the United States and Europe, the drug costs between Dh17,000 and Dh25,000 in the first month, reducing to Dh8,700 to Dh13,000 monthly. Medication would be free for Emiratis and some other insurance plan holders.

It is produced by Johnson & Johnson’s Janssen Pharmaceuticals and won approval by US drug watchdog the Food and Drug Administration in March.

The UK's National Institute for Health and Care Excellence is expected to decide if esketamine will be made available on the NHS in early 2020.

It is also recommended by a European Medicines Agency panel based on a series of long-term trials on patients who had not responded to conventional drugs.

When given esketamine, researchers found patients had a 51 per cent lower risk of relapse than those given oral antidepressants and a placebo nasal spray.

Esketamine is expected to be available at Abu Dhabi's Sheikh Khalifa Medical City from March.

“We are very much aware of this drug since its FDA approval and its potential benefits to patients,” said Dr Padmaraju Varry, a psychiatrist at NMC Hospitals.

Dr Varrey treats about 20 patients a week with depression, but not all are suited to existing drugs, he said.

“Depression is a common issue here in the UAE, like any other country,” said Dr Varrey.

“The stigma is moving away as people become more understanding of the symptoms because of positive media and information campaigns.

“People now appreciate it is a recognised medical condition and there is effective treatment out there.

“Relaxing this stigma means we are seeing more patients who are now prepared to come forward for treatment and accept they have a problem.

“We are looking forward to the availability of this medicine to help more patients in Abu Dhabi.”