A promising new treatment for people experiencing treatment-resistant depression will soon be available to even more Australians. Beginning May 1, Spravato (Esketamine) — an esketamine nasal spray — will be covered under Australia’s Pharmaceutical Benefits Scheme (PBS). Through our initiative, eligible patients can receive their medication for just $31.60 per dose, inclusive of shipping costs. For pensioners and concession holders the fare falls to a mere $7.70.
Spravato provides a new approach to addressing depression that hasn’t responded well to conventional medicines. This treatment is very much like ketamine, in that respect. ALEXIS HUTCHEON, 34, youth mental health researcher I began using Spravato in 2022. She’d dealt for years with oral antidepressants that failed her. She said she noticed positive changes immediately and almost “right off the bat” after going on the new treatment.
Hutcheon stated, “I was that depressed that my body was experiencing such horrible physical symptoms due to my deteriorating mental health.” After exhausting one treatment option after another with no real relief, she finally felt relief and hope with Spravato. “I was always waiting for the moment where it stopped working, but it’s been a number of years now, and things have improved and improved,” she added.
As it stands, the PBS listing will save and improve the lives of thousands of Australians living with treatment resistant depression. Ian Hickie, co-director of the Brain and Mind Centre at the University of Sydney, emphasized that Spravato represents a significant advancement in available treatments. “It’s a really different compound to the available antidepressants we’ve had over recent years,” he noted.
It should be noted, Hickie highlighted significant challenges in access. The financial burden of traveling long distances to reach clinics where treatment is administered presents an added barrier for many patients. “The cost of medical specialist care generally in Australia is very high, and that has meant access to these compounds to be difficult,” he said.
Hutcheon echoed these concerns, stating, “Even though PBS-listing is one step forward, which we’re so happy for, there will still be a number of people who won’t be able to afford those private fees that occur to actually have the medication.” She welcomed the challenge of stigma tied to accessing mental health treatment and accessibility for those who need it most. “Seeking help can be difficult, especially due to stigma,” she said.
Beyond the cost of treatment, the way treatment is administered constitutes another barrier to receiving treatment. Patients treated with Spravato typically go to separate treatment sessions in a healthcare office or clinic. In these sessions, medical professionals keep them under observation for one and a half to two hours. Hutcheon described this experience: “You’re in your own room and you’re there for an hour and a half to two hours monitored by a clinician throughout the whole time.”
Research with ketamine as a treatment for depression has yielded encouraging results. According to Hickie, internationally around 50% of patients with treatment-resistant depression show a major response to this drug. “In trials, I’ve personally been associated with in Australia, we have found the same thing in specialist clinics here,” he said.
With these exciting results from clinical studies comes a worry about illicit ketamine use. In a national survey conducted earlier this year, over half (53%) of 740 people who frequently used illicit stimulants reported using non-prescribed ketamine. That’s up from just 49% the year before. Dr. Rachel Sutherland, the lead of the Drug Trends program, noted that the majority of users reported low-frequency infrequent use of illicit ketamine, typically less than monthly. Nearly 10% fessed up to using it at least once a week.
“It is important to note that most participants who had used ketamine reported infrequent use [i.e., less than monthly], although approximately one in 10 reported weekly or more frequent use,” Sutherland stated.
Now Spravato is available through the PBS. Experts are thrilled because they think it might provide a much-needed lifeline to the millions of people currently experiencing treatment-resistant depression. The subsidized cost may alleviate some financial barriers, allowing more individuals to access a treatment that has shown rapid efficacy.
