Self Medication

Acommendably to-the-point article in The Guardian last December put it like this: “A radical ketamine-like drug has been licensed for use in the UK [the drug was approved by the Therapeutic Goods Administration in Australia in March this year] for severe depression, a decision that offers hope to the millions of patients for whom conventional treatments have failed. Esketamine, taken as a nasal spray [Spravato], is one of the first rapid-acting drugs for depression and the first in decades that is thought to work in a fundamentally different way in the brain. However, psychiatrists are divided on the benefits, with some hailing esketamine as a game changer and others raising fears about the potential for addiction and abuse.”

There’s only one word out of these that I’d quibble with, and that’s the ugly, made-up adjective “ketamine-like”. If you believe the drug’s supporters – the ones hailing it as a game changer – esketamine has significant chemical differences to ketamine. These mean that it’s metabolised faster, while, unlike its prefix-free parent, it doesn’t bind to sigma receptors in the brain. As for those raising fears about the new treatment’s potential for addiction and abuse, many are inclined to see the difference between the two drugs in terms of profit margins.

Ketamine has been around for so long that its original synthesisers have lost their patent – it has become what is known in the drug world as “generic”. Having been used as an anaesthetic since the 1970s, recent tests have shown that it may be effective as an antidepressant. But no company will spend millions doing the necessary trials to make it a drug commonly prescribed for this malady, because it