by A revolution in the treatment of depression. This is what Josep Antoni Ramos-Quiroga, head of Vall d’Hebron Psychiatry, the arrival of esketamine, the first and only treatment approved in Spain to deal with the most difficult to treat depression. “Esketamine constitutes an innovation that responds to an unmet medical need,” says the doctor.
Major depressive disorder affects almost 40 million people of all ages in Europe and it is one of the main causes of disability. Spravato, the new fast-acting antidepressant, is a derivative of ketamine, a powerful anesthetic administered as a spray through the nose. Its approval and financing in Spain was the first good news in three decades for people suffering from depression.
According to WHODepression will become the most important disease in Europe and throughout the world in 2030. «To this we must add that major depressive disorder usually recurs in 75-80% of patients and becomes chronic (lasting 2 years). or more) in 15 to 20% of these people,” says Marina Díaz Marsá, president of the Madrid Psychiatric Society.
There are effective therapies, such as therapy. electroconvulsivemore complex and entails some risk, but the other alternatives are less effective, barely 17%, acknowledges Ramos-Quiroga.
“We are talking about a response of more than 60%,” emphasizes Ramos-Quiroga. And we cannot forget, he adds, that a “remission of the disease” is achieved, that is, “having almost no symptoms. And that happens in more than 50% of people.
The intranasal route It represents great potential due to its speed of action, reduction of systemic side effects and autonomy for the patient. “It is designed so that the patient can self-administer it under health supervision.” Ramos-Quiroga highlights that “it is much friendlier, since it is a device similar to that used for rhinitis.”
Furthermore, the hospital administration prevents abuse of the medication, as it cannot be purchased at the pharmacy. Thus, he adds, “adherence to treatment is guaranteed.”
immediate response
Another positive aspect is the speed of the response. Unlike other therapies, where it takes weeks to see its effects, «with esketamine the response is very fast since it is effective from the first 24 hours, reducing depressive symptoms on day 28 and the risk of relapse, and with a favorable tolerability profile. Thus, in the first week very significant changes are already seen.”
Finally, it is a safe medication, very clean and very grateful for the patient, since its side effects, due to the mechanism of action that the molecule has, are quite transitory.
Our experience, says Ramos-Quiroga, is that of a 1-month induction treatment, followed by 6 months of maintenance therapy. However, some studies have shown that the therapy is safe for at least three years, if necessary.
People with resistant depression, warns Díaz Marsá, present “a greater risk of suicide, 20 times greater than the rest of the population.”
In this scenario, esketamine provides a solution, says Ramos-Quiroga. «We know that 90% of people who commit suicide have mental health problems and of these, half have depression.. That is, of the almost 4,000 people who commit suicide a year, practically 1,800 had depression. And if we have a fast and effective drug, mortality from suicide could be better managed.”
Limitations to its implementation
One of the challenges is access to specialized psychiatric services. Ramos-Quiroga believes that digital health can be of great help since it can allow people to have more agile and faster access.
In this sense, the president of the Spanish Society of Psychiatry and Mental Health (SEPSM), Víctor Pérez Sola, considers that “the only solution to cover medical needs is to invest in research. With the objective, above all, that these advances reach people. Depression is one of the leading causes of disability. in the world although we have effective biological and psychological treatments.”
Dr. Ramos-Quiroga concludes that this therapy represents a paradigm shift in the approach to the most serious depressions, but he believes that there have been certain limitations in its implementation in our country. “In Spain it has been put as a third line, after the failure of three drugs and, from our point of view, it is completely reviewable and it would be possible to use it before that situation.”
We must not forget that one in three patients does not respond to treatment with conventional antidepressants.
