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A new ketamine-based antidepressant raises hope — and questions

The anesthetic drug’s long-term effects on people aren’t clear

FAST RELIEF A new drug based on the anesthetic ketamine relieves depression in hard-to-treat cases, but its long-term consequences are unknown.

With great fanfare, a new antidepressant entered the U.S. market in March, the first fundamentally new medicine for depression in decades. Based on the anesthetic ketamine, the drug — called Spravato — is intended to help people with severe depression quickly, taking effect within hours or days instead of the weeks that typical antidepressants take. But for all the hubbub, big questions have gone unanswered about the drug, developed by Janssen Pharmaceuticals, Inc.

Some psychiatrists are concerned that the drug was approved by the U.S. Food and Drug Administration based on skimpy data, under standards that were less rigorous than those required for previous antidepressants. It remains unclear, for example, what happens as someone stops taking the drug, as well as whether it has long-term effects.

The data on Spravato raise more questions than they answer, says psychiatrist Alan Schatzberg of Stanford University. “And I think that’s unfortunate.” Despite those unknowns, some psychiatrists are relieved to have another drug to try, particularly for people with depression so severe that other drugs have failed to help. Spravato “does something that very few things in psychiatry can do — it works for people who didn’t respond to other treatments, and it works fast,” says psychiatrist Dan Iosifescu of New York University’s School of Medicine. “I really welcome having another powerful tool in my toolbox.”

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