
Nasal spray medicine for treatment-resistant depression not recommended by NICE - DanBC
https://www.nice.org.uk/news/article/nasal-spray-medicine-for-treatment-resistant-depression-not-recommended-by-nice
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DanBC
I've linked the summary document. If you want the technical details they are
here: [https://www.nice.org.uk/guidance/gid-
ta10371/documents/129](https://www.nice.org.uk/guidance/gid-
ta10371/documents/129)

We hear a lot about novel treatments for depression such as ketamine or
psychedelics, so some people may be surprised by the NICE decision to not
recommend esketamine.

I'm pretty confident that esketamine will be approved by NICE in the future,
once the costs have dropped and when we have better quality research showing
the effectiveness.

Depression is an umbrella term that covers a wide range of different illness.

Some people with depression are going to have spontaneous remission -- they'll
get better even if we don't provide any treatment. Some people have reactive
depression and they'll get better if we change the situation they're in.

We know that short form talking therapy like cognitive behaviour therapy is
effective for about 50% to 60% of the people who try it. We know that
medication has similar effectiveness. We know that some people get most
benefit from a combination of meds and therapy.

But there are people who have chronic, severe, treatment resistant depression.

For some people with long-lasting, treatment-resistant, severe depression
where they are at risk of death by suicide we've used electro-convulsive
therapy. Some people think ECT was the best thing that happened, but others
tell us that it caused them harm.

For this small group of people ketamine is probably going to be useful.

So, why did NICE chose not to approve eskatamine nasal spray?

It wasn't being looked at for just this narrow group of people, but for a more
general group. The definition of "treatment resistant" being used in the
trials was "hasn't responded to two or more anti-depressant medications". The
trials had an unusually large response from the placebo group -- people with
supposedly treatment resistant depression were getting better after a placebo
treatment. The trials also haven't compared eskatamine nasal spray with
talking therapies -- this is a large gap in the research.

It costs £10,000 per course of treatment. That's a lot more than
antidepressants or talking therapies and so it would need to show clear
unambiguous benefits over those, which at the moment it cannot do.

And there's uncertainty about side-effects and what happens when people stop
treatment.

