Intranasal formulation of ketamine shows promise in rapid treatment of depression, suicidality

Intranasal formulation of ketamine shows promise in rapid treatment of depression, suicidality

Ketamine nasal spray shows promise in the fast treatment of major depression symptoms and suicidal thoughts, a new study revealed.

The researchers conducted their work with 68 study participants who were identified as depressed and at risk of committing suicide.

The double-blind study compared the standard treatment plus an intranasal formulation of esketamine, part of the ketamine molecule, to standard treatment plus a placebo for rapid treatment of symptoms of major depression, including suicidality, among individuals at imminent suicide risk.

At just four hours after treatment, those who were placed in the esketamine group already showed significant improvement - their depression levels and suicidal thoughts dramatically decreased - while those in the placebo group only showed better results after 25 days. The researchers then analysed its effects four hours, 24 hours and 25 days after first treatment. It's hoped that esketamine could bridge what's called the "efficacy gap", the time between symptoms and the time standard medications begin to have an effect. The measurement of suicide risk took into consideration both the patient's and clinician's perspectives.

The new AJP study is the latest piece of research showing ketamine to be a promising treatment for depression. Considering that almost all available antidepressants take days to have an effect, this could mean ketamine has a real future filling a current gap in depression treatment.


The rapidity of the ketamine treatment is of particular interest as most antidepressants take more than a month to become fully effective. That caution is also the focus of an accompanying AJP editorial also published online today.

"The interesting United States study confirmed the findings from successful studies into intravenous ketamine", said Dr James Stone from Royal College of Psychiatrists, "The main reason for its significance is because this is being developed by a drug company and it's potentially quite likely that this medication might become available as a treatment available on the NHS for depression".

However, the researchers, as well as members of the AJP Editorial Board, acknowledged the risky potential for abuse that surrounds the drug. The nasal spray will be required to undergo phase 3 trials before potential approval by the FDA.

Dr Robert Freedman, editor at American Journal of Psychiatry said in a statement that, "Protection of the public's health is part of our responsibility as well, and, as physicians, we are responsible for preventing new drug epidemics". The Editors suggest the need for broad input in the development of effective controls on the distribution and use of ketamine.

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