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NHS watchdog rejects the use of esketamine as an antidepressant despite a hype about treatment

NHS watchdog rejects the use of ketamine-like nasal spray as an antidepressant despite hype over-treatment

  • Officials say there is insufficient evidence that esketamine nasal spray works for a long time
  • NICE also said the £ 10,000 course price is too high for the NHS to fund
  • The drug that is administered via nasal spray is chemically similar to the version with party drugs

A radical depression treatment derived from party drug ketamine is set to be rejected for use on the NHS.

There has been hype about treatment for months – the first antidepressant with a new mechanism of action that has been licensed in 30 years.

But NICE says there is not enough evidence that it works in the long term and that the price – which exceeds £ 10,000 for the average course – is too high for the NHS to fund.

NHS watchdog NICE has rejected the use of party medicine ketamine as an antidepressant despite a hype about treatment

Last month, drug giant Janssen – a Johnson & Johnson subsidiary – announced that it had obtained a license to use “esketamine” as an antidepressant in Europe.

The drug, administered via a nasal spray, is chemically similar to the party drug ketamine, which itself was first developed as a tranquilizer for horses.

Experts greeted the licensing of the drug as a huge step for mental health because of a lack of progress in the field in recent decades.

But drug watchdog NICE said in the draft directive last night that it would not recommend treatment for use on the NHS.

It said there wasn’t enough evidence that it would work to keep depression at bay once a patient stopped taking the drug – and it’s too expensive.

NICE said in a statement: “Estimates of cost-effectiveness for esketamine are probably much higher than what NICE usually regards as a cost-effective use of NHS agents, so it cannot be recommended.”

Meindert Boysen, director of the center for health technology evaluation at NICE, added: “Our independent committee highly recognizes the impact of treatment-resistant depression on people, their families and caregivers, the clear need for effective alternative treatment options and the priority of addressing mental health challenges for the NHS.

“There is a lack of evidence to compare esketamine with all relevant comparators, and the committee concluded that cost-effectiveness estimates would probably be much higher than what the NHS usually considers value for money.”

The decision is in draft form only – and can be reversed when the NICE committee meets again in a few weeks.

Marjorie Wallace, general director of mental health SANE, said there is a great need for new treatments.

“People with depression currently rely on 30-year-old drugs,” she said.

“Although these drugs can save life for some people, they can have unpleasant side effects and they don’t work for everyone.

“It is therefore very disappointing that the first new connection that works on the brain in a fundamentally different way should not have passed this obstacle.”

But Professor David Curtis, honorary professor at University College London, said: ‘This new guidance from NICE seems very sensible.

“Many psychiatrists are concerned about the lack of evidence that esketamine is really a useful treatment for depression.

‘There are also unanswered questions about the extent to which it can cause unwanted effects and how it can be used safely in practice.

“On this occasion, NICE is completely right to wait for additional information, including the results of further research, rather than allowing esketamine to be used in routine clinical practice.”

Dr. Paul Keedwell, psychiatrist consultant at the University of Cardiff, said NICE’s rejection was “disappointing.”

He said: “A significant number of people suffering from major depression do not respond to two or more conventional antidepressants.

‘New approaches are needed to reduce the social costs of long-term suffering, disabilities and chronic care needs.

“The NICE refusal to recommend intranasal esketamine for the treatment of treatment-resistant depression (TRD) will therefore disappoint many patients in the UK who have not responded to existing treatments.

‘The committee’s objection to its use in TRD appears to be largely based on costs rather than a lack of effectiveness.

“Although it is an expensive treatment, the additional costs for promising new drugs must be compared to the financial burden of persistent depression.”

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