Singapore – Ketamine, a controlled substance best known as a horse tranquilizer and party supplement, has become a boon for scores of severely depressed patients in Singapore over the past four years.
Since then October 2020 – When health science authorities first approved the sale of esketamine nasal spray for severe depression, five psychiatrists who used the therapy on their patients reported excellent results.
Four of the doctors said the majority of their patients achieved remission or recovery, and a fifth doctor reported that the remission rate was one in three for 16 patients. About half of them experienced a 50% reduction in symptoms, he added.
Consultant psychiatrist Christopher Chan said: “Compared to other options, this is expensive.”
He added that the ketamine nasal spray Spravat, once considered an alternative option, is now a mainstream prescription for treatment-resistant depression and is often recommended in standard guides.
Pharmaceutical giant Johnson & Johnson, the spray’s maker, declined to reveal the Singapore figures, but Spravato was available at approx. 2,800 treatment centers worldwide by end of 2024according to industry publications.
Johnson & Johnson’s neuroscience darling, Sprabat, is reserved for patients with treatment-resistant depression (when they don’t respond to two or more medications) or who are at risk of suicide.
scraped together US$780 million (S$1.07 billion) johnson & johnson first nine months of 2024 And it seems poised to be declared a “blockbuster drug” with annual sales of $1 billion.
Physicians who have treated more than 50 patients with the prescription drug say its appeal lies in its fast-acting and non-invasive procedure.
Senior Consultant Psychiatrist Victor Kwok, who has been offering Sprabat treatment since December 2020, said: Some people improve after two sessions. ”
More than 15 patients have received ketamine therapy at his Farrer Park Hospital clinic, including lawyers and social workers.
At his clinic, Private Space Medical, patients self-administer sturdy containers of nasal spray in one of several pigeon-gray rooms, supervised by a doctor.
The lights are then dimmed and the patient listens to their favorite music on headphones. They rest about 1 person 1 1/2 However, your doctor will visit you regularly until the effects wear off. Only then can you leave the clinic.
The first few sessions, called the induction period, can be “unstable” and need to be watched more closely, says a former patient with post-traumatic stress disorder who fell into a state of childhood fear. said Dr. Kwok, who examined the patient.
The ketamine nasal spray Spravato, once considered an alternative option, is now a mainstream prescription for treatment-resistant depression.Photo: PR Newsweek
He added that an out-of-body feeling known as dissociation is the most common side effect, along with dizziness, nausea and increased blood pressure, and that doctors are measuring these symptoms before and after administration.
By the fourth or fifth session, these problems diminish as the patient approaches the maintenance phase. Dr. Kwok said: Some people can read books, answer emails, and shop for groceries. ”
Ketamine can cause dream-like floating sensations and dizziness in the small doses prescribed.
However, the actual intended effect is between sessions, and this drug glutamic acid Dr. Kwok said traditional antidepressants are not targeted.
“This is like my secret weapon. It should work, but if it doesn’t, I’ll reconsider the diagnosis,” some psychiatrists said. 15 years.
Dr. Adrian Wang, He, who runs his own clinic at Gleneagles Medical Center, said he has given Spravat to 17 patients so far, and the treatment has only failed twice.
“One woman stopped because she didn’t like the dissociative feeling, and another patient completed the course, but we don’t know why it didn’t work.
“It’s all about patient choice.”
Patients should not have addictive tendencies or personality disorders, he warned.
In any case, the risk of abuse or dependence is very low, as the drug can only be taken in clinics at fixed doses and intervals, Dr. Wang added.
But the high price tag is prohibitive and could hinder widespread adoption, he said. Neuropsychiatric Associates medical director Mr. Pun Sihui.
On average, one session costs $1,000, but And that can add up quickly.
course Start at 8 weeks However, the frequency decreases over time, but it usually lasts six months and can last indefinitely. Dr. Poon said one of her patients has been taking Supravat for more than two years.
K, a 27-year-old marketing executive, has been using Spravato for a year and a half. $55,000 so far.
“As far as I know, most insurance companies don’t cover this treatment because it’s relatively new and is only given to more severe cases.” in the first month only. It cost $12,000. That’s three times my salary. ”
At Private Space Medical, where Dr. Kwok provides treatment at cost price to patients with low financial resources, Ms. S, a 30-year-old nurse, $15,000 in 5 months, out of pocket.
The bill does not include the cost of oral antidepressants, which must accompany a Sprabat course, or the cost of doctor-recommended talk therapy.
Doctors say that even after a successful full run of Spravato, patients typically need to continue with both to prevent recurrence.
A cheaper alternative to intravenous ketamine – Available at Mental Health Institute from 2024 – Not permitted for use in private clinics. It will cost approximately $3,200fOr 8 courses.
Still, the cost of ketamine therapy should be compared with alternative treatments such as electroconvulsive therapy or psychiatric hospitalization, said Dr. Tei Kai Hong, a psychiatrist for more than 15 years.
These can involve loss of freedom, institutionalization and suffering associated with stigma, he added.
For Mr. K, it worked.
She said: “When I tried Sprabat, I had been on medication for nearly seven years, and the results were mediocre.
“Then I attempted suicide in December 2022, so at this point I was desperate to try something.”
She immediately quit her job and began treatment. A few months later, she accepted a new job.
she said: “It gave me the resources and energy to get my life back to a place where I could live it again. Sprabhat can be effective, but it should always be used in conjunction with therapy.”
participate ST’s WhatsApp channel Get the latest news and must-read information.
