The National Institute for Health and Care and Excellence (NICE), the healthcare watchdog for the National Health Service (NHS), has rejected a fast acting antidepressant spray.
NICE decided to reject the ketamine-like antidepressant spray that can lift mood within hours on NHS due to uncertainties about the link between the price and clinical benefits of esketamine.
Esketamine, also known as Spravato and manufactured by Janssen, is a form of ketamine that targets glutamate, a chemical linked with learning and memory. Ketamine, which is used in medicine to numb the body or induce sleep, has a reputation for recreational misuse.
The spray is licensed as a therapy for people with hard-to-treat depression and costs around £10,000 per patient for a single course of treatment.
According to NICE's draft recommendation for NHS England and Wales, people currently prescribed with the antidepressant spray would be able to continue on the treatment if their doctor gives them approval.
Dr. Sameer Jauhar of the Institute of Psychiatry, Psychology and Neuroscience at King's College London, said NICE had made the decision because there was not yet enough long-term evidence to support the use of nasal esketamine alongside another antidepressant.
On the other hand, consultant psychiatrist Dr. Paul Keedwell of Cardiff University argued that patients would be disappointed by a decision based largely on cost rather than lack of effectiveness.
Marjorie Wallace, chief executive of mental health charity SANE, said: "People with depression are currently relying on medications that are 30 years old. Although these drugs can be life-saving for some people, they can have unpleasant side-effects and do not work for everyone."
"It is therefore deeply disappointing that the first new compound that works in a fundamentally different way on the brain should not have passed this hurdle. This is especially so because people can take as much as six to eight weeks to feel the full effects of most anti-depressants," pointed out Wallace.
She added: "We hope this setback will serve only to inspire pharmaceutical companies, researchers and others to discover new ways of treating serious depression."
NICE's draft guidance is open for consultation until February 18, 2020.
