The landscape of depression treatment—as well as some other mental health issues—particularly in Australia, is set to change dramatically. Starting May 1 Spravato will be covered under the Pharmaceutical Benefits Scheme (PBS). Spravato, which contains esketamine, represents the first new class of depression medication funded by the federal government in the last three decades. This development offers hope to the approximately one in seven Australians affected by depression, particularly those classified as “treatment resistant,” who have struggled to find effective relief through traditional methods.
Unlike conventional antidepressants, esketamine alters brain circuitry in unique ways, introducing a new treatment approach to hard-to-treat depression. Before Spravato was available on PBS, its cost exceeded treatment thousands of dollars. As we heard, patients experienced tremendous out-of-pocket costs throughout their entire treatment pathway. After it is listed, patients will pay at most $32 per dose. This breakthrough treatment will become much more accessible to patients.
The Science Behind Spravato
Spravato is a nasal spray that uses a novel form of ketamine. It influences brain chemistry in ways that are different from conventional antidepressants. Unlike typical antidepressant medications, which often take weeks to show results, patients may experience mood improvements within hours of administration.
“Then some hours later, many people report that their mood lifts on that day — not as we typically see with antidepressants some weeks later.” – Ian Hickie
The rapid response of Spravato may offer a vital lifeline for individuals who have cycled through numerous treatments without success. Those like Samuel Hockey who emerge from treatment have often endured decades of debilitating depression, anxiety and suicidal ideation. After running the gamut of other treatments, including multiple antidepressants and antipsychotic cocktails, Hockey says that Spravato opened up a new path toward recovery.
As you might expect, experts are thrilled at the promise of Spravato. They caution that long-term use of ketamine can be very dangerous, even triggering permanent bladder damage. Colleen Loo, another researcher at the trial, says only trained clinicians should be giving patients this treatment and should closely monitor them the entire process.
“As ketamine treatment … becomes more common, I think it’s very important for people seeking this treatment to go to a good clinic with good standards.” – Colleen Loo
Implications of PBS Listing
The inclusion of Spravato on the PBS is a huge step forward. Experts warn that a lot more work is needed to make sure this treatment is actually available to all. While the cost per dose will go down dramatically, patients remain on the hook for out-of-pocket costs to access care.
“While the PBS may cover the medication we still have to pay for the clinical room and the two clinicians,” – Sam Hockey
Hockey’s journey serves as a case study of why expanded support systems are critical. We need to improve our funding models so that every Australian can get the treatments they need and deserve. He feels like this PBS listing is just the beginning. It will go a long way to delivering life-changing tools to our youth and adults in the fight against treatment resistant depression.
“I think [the PBS listing] is just the beginning to make it affordable and accessible for other young people and people experiencing treatment-resistant depression.” – Sam Hockey
Looking Ahead
As healthcare providers prepare for the rollout of Spravato, experts emphasize the importance of proper training for clinicians who will administer this new treatment. As Colleen Loo puts it, the medication is a significant new breakthrough. We need to face regulatory barriers head on, preventing unqualified practitioners from delivering treatments with little to no oversight.
“From a regulatory point of view, there’s nothing to stop you setting up a [ketamine] clinic regardless of what training you have or haven’t done.” – Colleen Loo
Ian Hickie is robustly pro this kind of perspective. He stresses the need for medical oversight, as Spravato has acute effects on patients’ mental states. He hopes that public hospitals and clinics will soon make this treatment available for those unable to afford private alternatives.
“What I really hope will happen now is that public hospitals and clinics will make this available for those who cannot afford private clinics.” – Ian Hickie
Australia is making great strides in its innovative, at-scale national treatment of depression. Though Spravato represents a bold new leap in the direction of mental health care, ensuring patient safety and access is paramount to its success.
