DAVID GREENE, HOST:
For the first time in decades, the FDA has approved a major new drug to treat depression. It's a nasal spray that can relieve symptoms in hours rather than weeks. This medicine is called Spravato. And it's produced by Johnson & Johnson. It's based on the anesthetic ketamine, which has a reputation as a club drug. Psychiatrists such as Martin Teicher of Harvard Medical School have been studying the use of this drug to treat a growing number of disorders.
MARTIN TEICHER: I think it's, actually, one of the biggest advances in psychiatry in a very long time. It doesn't work for everybody. But it's sort of remarkable to have a treatment that can work pretty much immediately.
GREENE: NPR science correspondent Jon Hamilton is with me in the studio.
JON HAMILTON, BYLINE: Hi.
GREENE: All right - biggest advancements in psychiatry in a very long time. How is this anesthetic different than other antidepression drugs we've had out there?
HAMILTON: Well, I should say that scientists don't really know how any antidepressant works.
GREENE: Oh, interesting.
HAMILTON: (Laughter) But that said...
GREENE: But they work. I mean, they clearly have...
HAMILTON: They do work.
GREENE: They do work.
HAMILTON: They do work. But exactly what they're doing in the brain is still a mystery. And the thing they do know is that drugs like Prozac, the drug people probably know best, target the brain's serotonin system, whereas Spravato targets the brain's glutamate system. And it also, by doing this, may help the brain rewire itself, forming new connections.
GREENE: So the psychiatrist there said this is not - this drug won't work for everyone. Like - so who are the candidates who might use this nasal spray?
HAMILTON: This is a drug for people who have what is called treatment-resistant depression. And the way the FDA is defining that right now is that you have to have failed to respond adequately to at least two other treatments for depression. And a few months ago, I spoke to a patient who was - had depression and had not responded to any drug - he tried everything - until he was prescribed ketamine. This guy's name is James. He's an advertising executive. And he didn't want us to say his full name because he was afraid it would hurt his career.
JAMES: My wife took a summer off to be with me because she was scared of what was going to happen to me. She would go to work for a few hours, rush home. There'd be times I'd call her, just screaming, please come home. I can't get through another minute.
HAMILTON: So the amazing thing is that when James started on ketamine, he totally recovered. He was able to go back to his job. He said he felt calm. And there are a lot of people like James out there. There are about 5 million other people in the U.S. who have this sort of treatment-resistant depression. And for them, this could be a real lifeline, this new drug.
GREENE: So the FDA approving it is something that you can use if other treatments have not worked. Is that a sign that the FDA's being really cautious with this?
HAMILTON: Yeah. And there are good reasons to be cautious. We mentioned it's a club drug. And Spravato, like ketamine, which it's based on, it can produce some pretty major side effects. People talk about memory loss, a sense of being unable to control their bodies, hallucinations. I mean, it's a lot. And so patients won't be able to take Spravato at home. The whole idea is that they will have to go to a certified treatment center to take this. And then they will be observed not just when they take the drug but for a couple of hours after to make sure the side effects aren't a problem.
GREENE: But it can work really quickly, right? I mean, does that mean that this is something that people will use in a real crisis?
HAMILTON: It could be. But the effects of ketamine are almost instantaneous. People talk about feeling better within hours. However, the effects wear off with most patients after a few days or a week. And so people are going to have to go back and take additional treatments at first for - twice a week and maybe once a week after that.
GREENE: NPR science correspondent Jon Hamilton with us in the studio this morning. Jon, thanks as always.
HAMILTON: You're welcome.
(SOUNDBITE OF LULLATONE'S "TRAIN TICKET TO TOKYO")
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