On February 12, 2019 the FDA advisory committee recommended approval of Spravato (esketamine) for adults with treatment resistant depression. Hallelujah! The first new therapy in 30 years for patients suffering from this affliction, or is it?
Ketamine has been an FDA approved anesthetic since 1970 and in the last 10-12 years, some of the most reputable universities, hospitals and medical organizations including the National Institute of Mental Health have noted that Ketamine, given in low doses, can safely and effectively reduce the symptoms of depression. The primary hesitation has always been, “well, we don’t know the long-term side effects that Ketamine can cause” argument.
Ketamine Wellness Centers, in addition to several other national providers, have been treating patients, with zero serious side effects, since as early as 2010. At this point, KWC has provided well over 14,000 infusions and celebrates a success rate of over 80%. Are we going to know the long-term side effects of Spravato (esketamine) prior to its release? There certainly won’t be 8+ years of results before we are inundated with commercials touting it as the greatest breakthrough in the treatment of Depression.
So, let’s get down to it and dispel some rumors:
My insurance will pay for the treatment
Ketamine infusion therapy is expensive and insurance won’t cover it because it is considered an off-label treatment. However, there is no guarantee Spravato will be covered by insurance just because it is FDA approved for the treatment of depression. It’s important to remember that insurance companies make the decision on which medications they will cover and which ones they won’t. That decision might be made based on cost, time in use, and efficacy compared to alternatives or generic medications. Initial reports are putting Spravato at $500 per dose, just for the medication. That does not include the two hours of patient monitoring and any other associated costs. I can hear the insurance medical directors shaking their head as I type this.
Spravato is so convenient
Although Spravato is to be administered through intranasal (via the nose), patients will still have to physically go to a physician’s office for each treatment. So, not only will this medication be required to be administered in a medical clinic, the patient will also have to be monitored post-administration for a minimum of two hours. The duration of that entire process will no doubt exceed the majority of individual ketamine infusion treatments for mental health conditions.
I won’t have to be stuck with a needle
Well, you’ve got us there, but the current ketamine compound used for infusion therapy can be delivered intranasally, as well. In fact, many physician’s offices who are unequipped to provide intravenous ketamine have utilized the intranasal delivery option. But at the end of the day, the gold standard for effective delivery of Ketamine is intravenous. Clinical testing has shown time and time again that it requires precision to get the optimal patient outcome, which is impossible to do with oral or intranasal forms of administration.
The stigma behind using “Special K” will be gone
We certainly hope that alternatives such as Spravato help to diminish the negative stigma associated with mental health conditions and the use of clinical ketamine. We are pleased to see that Ketamine continues to gain acclaim, publicity, and social support. In all honesty, we don’t view the addition of Spravato as a bad thing. If anything, we are excited it is bringing more attention to the use of Ketamine as an effective treatment of debilitating mental health conditions.
Ultimately, it’s our hope that if third-party payers choose not to accept the new Spravato medication into their formulary, they may consider the generic version of Ketamine as an alternative. While we feel cautiously optimistic over the release of Spravato for various reasons, we are confident that the gold standard of ketamine treatment therapy is already available. The transformational stories our patients express to us is evidence enough.
There is hope. There is help. Now.
Authored by Kevin Nicholso: President and CEO Ketamine Wellness Centers, as well as a registered nurse who has treated hundreds of KWC patients that have come through our doors.