How the FDA's approval of esketamine will impact Americans with depression

EAU CLAIRE, Wis. (WEAU) -- Depression affects millions of Americans each day, but last week the FDA approved a new drug that some say will be life changing for those battling the disorder. It's called esketamine and it's a nasal spray. There is a similar treatment out now called ketamine therapy where patients come in and get the medicine via IV under the careful watch of a doctor.

Tyler Mickelson sat down with WEAU Health Correspondent Dr. Alicia Arnold to learn more about the treatments. Their Q&A can be found below.

This nasal spray is being called a "game-changers" by some doctors, what makes it different?

Dr. Alicia Arnold, “A significant percentage of people with depression have what we call treatment resistant depression. That means that they have not responded adequately to trials of at least two different medications. This nasal spray is a new mechanism of action, so it works in a different way, and may offer a new form of treatment for whom more standard therapies haven’t worked. Depression can have a devastating effect on patients and their families and there is a need for additional effective treatment options.”

So, these medications offer an additional treatment option, are there any other advantages they might offer?

Dr. Alicia Arnold, “Many anti-depressant medications take time, even weeks or months, to take effect. IV ketamine or the nasal spray form may take effect much more quickly so patients start to feel better sooner.”

Is this a medicine that will become the "go-to" for patients? Or, is this seen as a last resort right now?

Dr. Alicia Arnold, “Currently, this is an option that could be considered when the more standard treatments for depression aren’t working adequately. Although the early data suggests that ketamine is safe, we don’t have long-term data about the safety and effectiveness of this medication. Also, it has to be administered in a certified treatment center, so this isn’t something that lots of doctor’s offices will be offering.”

We have to talk about the price. Right now esketamine is between $4,700 and $6,500 for the first month, but on the other side you can get six infusions of the ketamine IV infusion for a little less than $3,000. Do insurance agencies look at these FDA approvals closely?

Dr. Alicia Arnold, “Ketamine was FDA approved decades ago for anesthesia. IV use of ketamine for depression is off-label, meaning the medication wasn’t specifically approved for treatment of depression. Many insurances don’t pay for off-label use of medications. Esketamine is a form of ketamine that is specifically approved for treatment of depression, so hopefully there will be better insurance coverage for the treatment.”

Ketamine has often been abused as a party drug known as "special-k", what's the risk with this drug? If somebody thinks they can "self-diagnose" themselves, what problems could they run into?

Dr. Alicia Arnold, “Ketamine has been abused for years as a club drug, often at high doses. It has the potential to cause hallucinations and can make you feel not like yourself and alter your perception of your surroundings. Some of the potential side effects for esketamine include sedation, altered thinking, and abuse of the drug. You aren’t even supposed to drive on the day it is given, so this isn’t something to be taken lightly. It is tightly regulated and only approved to given in a doctor’s office and under supervision. So this is not the kind of thing you can or should try to treat yourself with.”