science of us

Can a Party Drug Really Treat Severe Depression?

Nasal spray.
Photo: Florian Gaertner/Photothek via Getty Images

While ketamine has a bad — or great, depending on who you ask — reputation as a street drug, it turns out the anesthetic can do more than slide you into a dissociative state in a crowded nightclub: It can also help your mental health.

On March 5, the U.S. Food and Drug Administration announced that it had approved Spravato, a ketamine-like nasal spray for severe depression that experts are heralding as the first novel antidepressant to hit the market since Prozac did 35 years ago. (The active ingredient in the spray is esketamine, which is the chemical cousin of ketamine.) “There has been a long-standing need for additional effective treatments for treatment-resistant depression, a serious and life-threatening condition,” Dr. Tiffany Farchione, acting director of the Division of Psychiatry Products in the FDA’s Center for Drug Evaluation and Research, said in a press release. And Spravato, health officials believe, might be that long-missing treatment.

While there are still many unanswered questions around the drug — for example, when it will be released? — here’s everything that we know so far.

First things first: What is ketamine?

According to a 2016 study of the drug, ketamine was introduced into a clinical setting as an anesthetic in the 1960s. But if you’ve ever gone to a party and been offered Special K, you’ve come in contact with ketamine. Because the drug temporarily blocks the action at the body’s glutamate receptor NMDA, which is the body’s main excitatory chemical messenger, it puts you into a trancelike state that makes you feel relaxed and pleasantly disconnected from reality.

And what exactly did the FDA approve?

It’s a nasal spray called Spravato, which is distributed by Janssen Pharmaceuticals, a division of Johnson & Johnson Inc. And though much of the coverage around the drug has characterized it as pure ketamine, the spray bottle actually contains esketamine, which is the chemical cousin on ketamine. (It is used for similar indications as ketamine, upon which the anesthetic is based.) Unlike the party drug, the spray isn’t something you’ll be able to easily use recreationally.

“Because of safety concerns, the drug will only be available through a restricted distribution system and it must be administered in a certified medical office where the health care provider can monitor the patient,” Farchione said in the press release.

How exactly does it help treat depression?

Over the past two decades, Stat reports that scientists have been studying ketamine’s potential as a depression treatment, which works differently from traditional antidepressants. All prior antidepressant treatments, such as selective serotonin reuptake inhibitors (SSRIs), temporarily block the body’s reabsorption of serotonin. Ketamine, on the other hand, targets a completely different set of neurotransmitters and receptors: the glutamate system. Therefore, the FDA-approved nasal spray could be a breakthrough drug for people with treatment-resistant depression, which applies to those who have persisting symptoms of depression, despite having tried at least two full treatments with different traditional antidepressants.

“Because it works through a different chemical signaling system than the standard antidepressants, people who do not respond to standard antidepressant medications may still respond to ketamine,” Dr. John Krystal, chief of psychiatry at Yale-New Haven Hospital, who has been studying ketamine since the 1990s, told the Cut.

Are there any concerning side effects?

As with any drug, there are side effects. Per the press release, the most common ones include “disassociation, dizziness, nausea, sedation, vertigo, decreased feeling or sensitivity (hypoesthesia), anxiety, lethargy, increased blood pressure, vomiting and feeling drunk.” There are also specific groups of people who are advised against taking the drug, such as breastfeeding or pregnant women. But, as always, this is a conversation to have between you and your doctor.

So could you, say, get addicted or fall into a k-hole?

Technically, it’s possible. However, Krystal told the Cut that he believes “the addiction risks of ketamine can be managed effectively by limiting the administration of ketamine to clinic settings.”

“I [would be] very concerned that if people took home large amounts of ketamine to use as they saw fit, that they would be vulnerable to developing addiction or other complications of ketamine treatment,” he said.

Is there a release date yet?

As of now, no. In an email to CNN, Greg Panico, a spokesman for Janssen said they are “working quickly to educate and certify treatment centers on the unique administration requirements of SPRAVATO to ensure patients can access this important medicine.”

But when it does become available, it won’t exactly be easily accessible. While Panico says the cost will be “generally comparable with other specialty mental health drugs,” that means about $590 to $885 per treatment session.

Clearly, this is more than just a club drug.

Can a Party Drug Really Treat Severe Depression?