The FDA has approved a new fast-acting depression treatment derived from a party drug. Nasal spray esketamine from Johnson & Johnson's Janssen Pharmaceuticals contains an active portion of the ketamine molecule. As a generic anesthetic, ketamine or "Special K" is increasingly available for depression, but costs a pretty penny and is hallucinogenic. Esketamine, to be marketed as Spravato, is thought to be more tame, with side effects including feelings of intoxication and dissociation, dizziness, and nausea, per NBC News. The drug goes into effect in as little as four hours, compared to weeks for anti-depressants, and is approved for people with treatment-resistant depression. Per the New York Times, some 4 million American adults are in that camp and "represent perhaps the greatest unmet need in psychiatry."
However, esketamine did not always statistically outperform placebos in trials, and appeared to be less effective in people 65 and older, per the Times. There is also the potential for abuse. As the director of the Yale Depression Research Program tells NBC, "we're a long way from this being an at-home or over-the-counter drug." A recommended course of twice a week treatments for four weeks, plus boosters, is to be administered only in a doctor's office or clinic, with patients monitored for at least two hours. Treatments cost $590 to $885 per session, per CNN, which notes the drug works by restoring brain cells. At Bloomberg, Faye Flam points out it's likely to be covered by many insurance plans. She notes IV infusions of ketamine "cost between $350 and $1,000 each, and can go on for five or six treatments." ('Shrooms could help, too.)