UMass Medical School depression expert Anthony Rothschild, MD, is conducting a clinical trial of a drug that he and many others believe may be today’s greatest hope for patients with treatment-resistant depression. Esketamine, a nasal derivative of the drug ketamine, is being tested to determine if it is safe and effective for long-term treatment in patients who have not responded to at least two other antidepressant medications.
“It’s estimated that about 12 percent of the U.S. population will suffer from major depression at some point in their lives,” said Dr. Rothschild, the Irving S. and Betty Brudnick Chair in Psychiatry, professor of psychiatry and director of the Center for Psychopharmacologic Research and Treatment at UMMS. “Of that group, about 15 to 20 percent will suffer from treatment-resistant depression, so that’s a lot of people who could benefit. The mechanism of ketamine works on a different neurotransmitter system, the glutamate system, that has a very different mechanism of action from any medications we’ve used to date, including those that affect serotonin, norepinephrine and dopamine.”
Known as both a legal anesthetic and an illicit party drug, ketamine has recently been found to be remarkably effective for immediate, dramatic relief for persistent depression.
“That’s the good news. The downside has been that it doesn’t last,” said Rothschild. “We’re studying whether people will derive continued benefit from the medication, and whether there are any long-term side effects.”
The study will accomplish this by providing patients with twice-weekly doses of the nasal spray esketamine in the clinic over a one-month period. After each dose, patients will remain in the clinic for several hours so that they can be monitored closely to assess the drug’s ongoing therapeutic impact and potential side effects.
“This is a very exciting time in depression research,” said Rothschild, who has spent more than 30 years treating patients and studying the diagnostic challenges, biology, course and treatment of major depressive disorders. “We’re very fortunate that we are able to participate and provide [these drugs] to our patients.”
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