A variant of the popular ’90’s party drug ketamine that was discovered to treat severe depression, called esketamine, will be available to Yale students within the next month following its recent approval by the Food and Drug Administration on March 5. The medication is not covered by Yale Health.

According to Director of the Yale Depression Research Program Gerard Sanacora, esketamine is designed to treat patients with moderate to severe depression who have not found success through more traditional therapies or through medications such as Prozac or Zoloft. Since it targets a different set of the brain’s neurotransmitters, he said, the drug could start to produce significant benefits within hours to days, compared to monthlong treatment timelines typically seen in other antidepressants.

However, because of esketamine’s strength, relative newness and potential for abuse, caution is necessary when dealing with the drug.

“The whole discovery of this rapid, antidepressant-like effect with ketamine is a huge advance for the field,” Sanacora noted. “It really, in my opinion, is one of the major breakthroughs in the field in the past five decades. That being said, I think we really need to be very responsible and reasonable about how we use this drug.”

Current FDA guidelines only allow the drug to be administered through a nasal spray in the presence of a medical professional. This safeguard is meant to protect against the risk of dissociation associated with esketamine, as well as to deal with any other potential side effects, including vertigo, anxiety, nausea and dizziness. According to the FDA press release, patients should not drive for the rest of the day after taking the drug.

According to Chief of Psychiatry at Yale New Haven Hospital John Krystal, the Interventional Psychiatry Service at the hospital will provide esketamine to patients on a twice-weekly basis. This will be tapered down over time, he said, to generally one dose every two to eight weeks.

“The Interventional Psychiatry Service at Yale New Haven Hospital, led by Drs. Robert Ostroff and Gerard Sanacora, was one of the first clinics in the United States to provide ketamine as a routine treatment for treatment-resistant symptoms of depression. It is one of the sites where esketamine was tested,” he said.

Krystal also noted that researchers at Yale have experimented with combining ketamine and the anti-addiction drug naltrexone to limit the risk of abuse. Preliminary evidence has shown that this combination may improve depression symptoms without leading to addiction.

Still, for many students at Yale, the cost of the drug may prove to be prohibitive. Since the medication is not covered by Yale’s insurance, students will have to pay through other means to be able to take the drug. At a list price of between $590 and $885 per dose, one week of treatment costs well over $1,000.

Despite the cost, Sanacora said that the drug will be an effective alternative to other anti-depression treatments.

“At this moment, this is for people with real, severe depression and are truly treatment-resistant, who have not responded to really good efforts with standard treatments,” he said. “This is not something to enter into lightly.”

Ketamine was first synthesized in 1962 by chemist Calvin Stevens at Wayne State University.

Matt Kristoffersen | matthew.kristoffersen@yale.edu