Depression is a mental illness. It is estimated that depression will affect 15 percent of all people at some point in their lifetime. The condition is caused by imbalances in certain brain chemicals called neurotransmitters. These neurotransmitters play an important role in controlling your mood. In addition to directly affecting depression, neurotransmitters have other bodily functions.
- Depression medications are the most prescribed class of medications in the world.
- Depression can cause a profound sense of sadness, apathy, worthlessness, and desperation.
- Depression can affect anyone, of any age, of any color and of any income.
- Depression is one of the leading causes of disability in the U.S.
- Depression can occur after a tragic life event or for no apparent reason at all.
- Depression can run in families.
- Untreated depression is the most common cause of suicide.
- Depression is treatable.
The Food and Drug Administration (FDA) has recently approved a new medication to treat depression. The new drug, esketamine, was developed by Johnson & Johnson and is a variation of the well-known drug ketamine. Ketamine is a fast-acting anesthetic that has quite a reputation as a drug used illegally at parties and even has the nickname “Special K.”
The FDA-approved esketamine spray (trade name: Spravato) works as a rapid therapy for patients who have failed to respond to at least two FDA-approved antidepressant medications. Almost eight million American adults suffer from this type of treatment-resistant depression.
While ketamine is given by an intravenous infusion, esketamine is given via nasal spray exclusively by a specially registered and specially trained physician in their office, often twice a month. Patients must be monitored carefully after receiving esketamine due to its (initial) mild psychedelic effects.
Ketamine has long been in use as a potent anesthetic to ready patients for surgery. Shortly before the turn of the century, it was popularized in underground drug-driven party cultures because it could produce psychedelic, almost out-of-body experiences. Some doctors have even given ketamine to patients to treat depression without official FDA approval.
Esketamine, however, is one of the first medicines designed to treat depression that has gained FDA approval in decades. It is the first significant pharmaceutical drug developed for depression since the approval of Prozac and several similar antidepressant drugs in the late 1980s. Those drugs focus on serotonin, a brain neurotransmitter that can make people feel good. Unfortunately, many drugs in this antidepressant class can take weeks or even months to work.
Ketamine and esketamine work differently as they do not target serotonin, but rather a chemical called glutamate. Glutamate is believed to restore brain connections that can, in turn, affect mood and treat depression.
Esketamine’s advantage is that it can work almost immediately. Instead of waiting weeks to months for depression to be relieved, patients can feel better right away. This is extremely attractive because patients suffering from depression are practically disabled and can suffer enormously. Additionally, depressed patients are at high risk of suicide.
The other advantage of a medication that works fast to treat depression is that, in the cases where it doesn’t work, both the patient and doctor will know right away and can then initiate a different treatment plan. Some patients suffering from depression who didn’t respond to traditional anti-depressant medications and then tried esketamine say that the drug is life-changing.
Initially, the medication produces an almost psychedelic effect. Because of its unknown long-term effects, its use by certified physicians and eligible patients will be carefully and strictly monitored by the FDA for several years forward.
Since it is so effective, researchers are also looking at other psychoactive psychedelic substances like psilocybin, the active component in psychedelic mushrooms, and MDMA, a euphoria-producing party drug, as possible treatments for mood-affective disorders such as post-traumatic stress disorder and depression.
As there are currently no alternative and effective therapies for those who fail traditional anti-depression medicines and treatments, esketamine shows extreme promise for the treatment of depression for both patients and physicians alike.
Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He received his M.D. and Master’s Degree in Molecular Biology and Genomics from the Mayo Clinic. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine. Dr. Crutchfield was recognized by Minnesota Medicine as one of the 100 Most Influential Healthcare Leaders in Minnesota. He is the team dermatologist for the Minnesota Twins, Vikings, Timberwolves, Wild and Lynx. Dr. Crutchfield is an active member of both the American and National Medical Associations, and president of the Minnesota Association of Black Physicians.