3 ms·

The WebMD article is referencing esketamine, also known as Spravato, which is an FDA authorized form of ketamine. It's generally indicated for longer-term use i

The WebMD article is referencing esketamine, also known as Spravato, which is an FDA authorized form of ketamine. It's generally indicated for longer-term use in patients with Treatment Resistant Depression (TRD), and has really good results on par with ketamine (IV or intramuscular). At Lumin Health, we treat about 80% of our patients with esketamine, and the rest with ketamine (generally only if they don't meet esketamine criteria). After the initial course, patients tend to find a good balance of ongoing care that helps treat their particular depression / depressive symptoms. This happens less with ketamine since it tends to be prohibitively expensive to continue care (upwards of $1k/month).

jonnycomputer 4y ago
Do appreciate informed commentary; thank you. I work in a research lab studying depression and the brain, but am not a clinician (which is why I threw in a lot of caveats).
robocat 4y ago
Any comments on https://slatestarcodex.com/2019/03/11/ketamine-now-by-prescription/ https://slatestarcodex.com/2019/03/11/ketamine-now-by-prescr... - presumably the doubts Scott had have now been answered?
- oaktrout 4y ago
  For those who don't want to read the article, the highlights for me were: 1) esketamine may not work as well as ketamine and 2) esketsmine was invented to make pharm companies money because they couldn't do it with ketamine.
- engined 4y ago
  In general, esketamine has been shown to have about the same efficacy as ketamine for Treatment Resistant Depression (TRD) and MDD. There seem to be some minor differences in bioavailability between esketamine and ketamine, but from experience, if one work, the other will, and if one doesn't, the other won't. Anecdotally, we've seen great results in a matter of weeks with patients who have had no success through numerous antidepressants, TMS, ECT, and other treatments. There is a long-term trial now in its 4th year with esketamine (https://clinicaltrials.gov/ct2/show/NCT02782104 https://clinicaltrials.gov/ct2/show/NCT02782104). I'm not sure how much has been published yet, but early data I saw supported immediate relief and long term benefit over the 4 years. In terms of it being a sinister ploy by pharma, it's definitely priced higher than its ketamine generic counterpart, but for the vast majority of our patients, ketamine treatment out of pocket (since its not covered by insurance) is absolutely unaffordable, and pursuing the insurer-covered version of treatment is a high-value option.
PTcartelsLOL 4y ago
1k/month? How much quantity is that? Black market prices in Europe is like €20/g only going down with the more you buy.

jonnycomputer 4y ago

Do appreciate informed commentary; thank you. I work in a research lab studying depression and the brain, but am not a clinician (which is why I threw in a lot of caveats).

robocat 4y ago

Any comments on https://slatestarcodex.com/2019/03/11/ketamine-now-by-prescription/ https://slatestarcodex.com/2019/03/11/ketamine-now-by-prescr... - presumably the doubts Scott had have now been answered?

oaktrout 4y ago
For those who don't want to read the article, the highlights for me were: 1) esketamine may not work as well as ketamine and 2) esketsmine was invented to make pharm companies money because they couldn't do it with ketamine.
engined 4y ago
In general, esketamine has been shown to have about the same efficacy as ketamine for Treatment Resistant Depression (TRD) and MDD. There seem to be some minor differences in bioavailability between esketamine and ketamine, but from experience, if one work, the other will, and if one doesn't, the other won't. Anecdotally, we've seen great results in a matter of weeks with patients who have had no success through numerous antidepressants, TMS, ECT, and other treatments. There is a long-term trial now in its 4th year with esketamine (https://clinicaltrials.gov/ct2/show/NCT02782104 https://clinicaltrials.gov/ct2/show/NCT02782104). I'm not sure how much has been published yet, but early data I saw supported immediate relief and long term benefit over the 4 years. In terms of it being a sinister ploy by pharma, it's definitely priced higher than its ketamine generic counterpart, but for the vast majority of our patients, ketamine treatment out of pocket (since its not covered by insurance) is absolutely unaffordable, and pursuing the insurer-covered version of treatment is a high-value option.

PTcartelsLOL 4y ago

1k/month? How much quantity is that? Black market prices in Europe is like €20/g only going down with the more you buy.