A new medicine chemically similar to the drug ketamine could be a "step forward" for Australians living with the "constant battle" of depression.
Thousands of Australians could be eligible to receive the nasal spray, called Spravato, which contains esketamine, at a subsidised rate through the Pharmaceutical Benefits Scheme (PBS) from 1 May.
It's the first medicine to be PBS-listed specifically for treatment-resistant depression and will cost $31.60 per dose, or $7.70 for pensioners and concession holders.
The medication is chemically similar to ketamine and would be offered to people experiencing treatment-resistant depression, like 34-year-old youth mental health researcher Alexis Hutcheon.
Hutcheon started using the spray in 2022 after years of "frustrating" failed attempts with oral antidepressants.
Hutcheon's journey with Spravato
Hutcheon said her depression largely manifested as physical symptoms like gut issues, sleeping problems, and losing a lot of weight. It got to the point where she struggled to walk to the front door, let alone leave the house.
"I was that depressed that my body was experiencing such horrible physical symptoms due to my deteriorating mental health," she told SBS News.
Hutcheon went through years of trying oral antidepressants with limited to no success.
"Some of them worked for a little bit, and then they didn't, and some of the side effects weren't something that I could handle, like no sleeping," she said.
"If it doesn't work, you get this feeling like you want to give up, or you feel like it's your fault."
Hutcheon first tried Spravato during a clinical trial in 2022 and noticed positive changes almost "straight away".
"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 said.
"Things haven't gone back to as bad as they were at all since I started using ketamine."
How Ketamine works for treatment-resistant depression
Ian Hickie, the co-director of the Brain and Mind Centre at the University of Sydney, has been working with patients who take Spravato.
He told SBS News its PBS listing marks a "significant advance".
"It's a really different compound to the available antidepressants we've had over recent years," he said.
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Hickie explained it's the first PBS-supported drug that targets a different chemical in the brain called glutamate.
"Internationally, about half the people with treatment-resistant depression demonstrated a significant improvement with this drug," he said.
"In trials, I've personally been associated with in Australia, we have found the same thing in specialist clinics here."
He said many patients have experienced a significant improvement in their quality of life, but cautioned it can cause some to feel "disoriented, disassociated, or quite unusual".
Strict clinical regulations
Ketamine therapy, along with other forms of treatment like psychedelic-assisted therapy, is highly regulated and is done in strict clinical settings.
Studies have shown low doses of oral ketamine can treat post-traumatic stress disorder, and in tablet form, can reduce the symptoms of severe depression.
These therapies are administered in hospitals and clinics under medical supervision.
"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," Hutcheon said.
Hickie said the cost of attending clinics can be hundreds or even thousands of dollars, which can create a barrier for people wanting to try the nasal spray.
"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.
He said many mental health treatments are only offered privately, and he would like public hospitals to "step up" and provide the "novel" treatment.
Despite the availability of ketamine therapy, illicit use of the drug is on the rise in Australia.
Use of illicit ketamine on the rise
A national survey of 740 people who regularly use illicit stimulants found over half had used non-prescribed ketamine.
Fifty-three per cent of those surveyed last year used the drug, up from 49 per cent the year before, according to the University of New South Wales' Drug Trends program.
The group releases annual surveys of hundreds of people who use illicit drugs living in each of Australia's capital cities.
Dr Rachel Sutherland, lead of the Drug Trends program, said use of illicit ketamine was "infrequent" in a survey report for 2024.
"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 said in the report.
Hutcheon said there is more to do to help people access therapeutic ketamine.
"Seeking help can be difficult, especially due to stigma.
"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."
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