A quick-acting nasal spray to combat suicidal thoughts is being made available in the United States as doctors worldwide become increasingly concerned about the mental health effects of COVID-19.
The drug Spravato has already been used by about 6000 people for treatment-resistant depression since its approval in March 2019.
But a decision by pharmaceutical company Johnson & Johnson to study it in depressed people actively contemplating suicide bucks a trend among drugmakers who routinely exclude such patients from trials.
Part of the thinking behind the decision was that Spravato’s ability to act quickly could mean it works differently than older antidepressants that can take weeks to kick in, Johnson & Johnson vice president Michelle Kramer said. In its studies, she said the company had found those who got the drug had a rapid reduction in the severity of their thinking.
The data from studies of the drug shows it “may offer clinicians a new way to provide support to patients quickly in the midst of an urgent depressive episode and help set them on the path to remission”, said Gerard Sanacora, director of Yale’s Depression Research Program and a trial investigator.
America has been in the throes of a suicide crisis even before the pandemic, with the rate rising 30 per cent from 1999 to 2016. COVID-19 closures limited the number of people given the spray as a depression treatment in-person at specified centres.
Ultimately, though, the numbers improved as patients and centres adapted and concerns grew within the mental health community that physical distancing and social isolation of quarantine may exacerbate people’s existing problems or introduce new ones.
“Relatively rapidly within a few weeks we saw the numbers stabilise, which was pretty interesting for us and validating in the sense that clinic and patients alike were continuing to make this available,” Kramer said. “We certainly see more and more sites sign on and more and more patients are treated.”
Spravato is a close chemical cousin of the anesthetic ketamine, which differs from existing antidepressants because it acts on the glutamate system in the brain rather than on seratonin or norepinepherine. Scientists have been working to better understand how the drug helps patients and why it works so quickly.
The drug’s approval last year marked the first major breakthrough for depression since 1987. US President Donald Trump has since trumpeted the drug as having the potential to curb veteran suicides, but a Veterans Affairs medical panel only approved the drug’s use on a limited basis.
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