'Breakthrough' nasal spray to treat depression coming to UAE

A “breakthrough” medication used to treat depression will be available in the UAE early next year.

The drug, called esketamine, will be sold under the brand name Spravato and is a ‘fast-acting’ medicines to treat the chronic disease.

Produced by Johnson & Johnson’s Janssen Pharmaceuticals, a single puff in each nostril has shown to improve a patient’s mental health within 24 hours.

Some medics have drawn reservations given it is similar to the party drug ketamine, though its use to treat depression and as an anaesthetic in a strict medical setting is being seen as increasingly effective.

It was approved by the Food and Drug Administration, the US drugs regulator, in March and last week it won recommendation for approval from a European Medicines Agency panel. It will be brought to Abu Dhabi’s Sheikh Khalifa Medical City as early as March next year.

Doctors are optimistic that Spravato will help patients who have not responded to two other conventional antidepressants, which can take weeks to have an effect.

“This medication works within four hours and is taken two to three times per week. It is not available [in the UAE] yet but we are working on making it available as soon as possible. Patients who have used it have reported improvement,” said Dr Medhat Elsabbahy, head of the psychiatric rehabilitation department at SKMC, at the Abu Dhabi International Mental Health Conference on Thursday.

Traditional antidepressants work by boosting serotonin — a neurotransmitter thought to have a good influence on mood, emotion and sleep — in the brain. Spravato is the first drug in decades to target a new brain pathway: glutamate, a neurotransmitter that plays an important role in learning and memory and is considered essential for normal brain function.

It is hoped the new medicine will be of particular use to patients who struggle to keep on top of their doses.

“One of the major problems that we face with patients is compliance with medication,” said Dr Tarek Darwish, Consultant Psychiatrist and Medical Director of SKMC’s Behavioural Sciences Pavilion.

“Patients are at a risk of relapsing if they stop the medication and so the current direction is towards medicines whose effects are long term, such as … the nasal spray."

The spray is absorbed through the nose and into the blood stream and should be taken with an oral antidepressant.

In the US and Europe, the drug costs between Dh17,000 and Dh25,000 in the first month and reduces to Dh8,700 to Dh13,000 monthly. Medication would be free for Emiratis and some other insurance plan holders but, because the drug is yet to be registered in the UAE, its cost here is still to be set.

To prevent abuse, the drug will be made available only through tight monitoring in the UAE.

“It will be used on patients suffering from severe depression and are not responding to other medications but it is too early to tell how it will be administered because it has not arrived in the market yet," said Dr Darwish.

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Spravato is seen as part of a new class of rapid-acting and long-affecting medications that treat mental health disorders.

Other breakthrough drugs include injections used to treat schizophrenia and bipolar disorder that are to be taken every three months instead of the conventional daily tablets.

“We have been in the field of psychiatry for 50 years. The nasal spray is our latest medication,” said Janssen Pharmaceutica representative, Magdy El Hameed.

He said the drug can initially be used once a week and later extended to once every two weeks.

“For esketamine to be abused, the patient will need to take 300 puffs at the same time and that is not feasible. Each canister contains one puff.”

Depression affects an estimated 350 million people around the world, and more women are affected than men.

In the Arab World, it is estimated that on average, 17.7 per cent of the population suffers from depression. The UAE government previously said this figure is likely to only be the tip of the iceberg because not everyone with mental health issues is comfortable enough to come forward and seek treatment due to the associated stigma.

Prof Ahmed Okasha, founder of the Institute of Psychiatry at Aim Shams University in Cairo, Egypt, and Adviser to the Egyptian President for Mental Health and Community Integration, said stigma remains a huge problem around the world, but particularly in the Arab World.

“We want to explain in two words that mental illness is a disease in the brain. It is not mystical like people believe it to be, it is not caused by jinn, evil eye or bad spirits. It is exactly like any organic disease."

He said the stigma is sustained because patients are often kept in hospitals by their family because they believe them to be harmful to others.

“Mentally ill people are discriminated against, they are isolated, hated and ostracised when they should be treated like any member of society.”