'Special K' — From Street Drug to FDA-Approved Depression Treatment

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If you’ve gotten little benefit from antidepressants or therapy for depression, a newly-approved option might help. Esketamine (Spravato) is a fast-acting nasal spray made from a common anesthetic, ketamine, that, as "Special K," was a popular club drug in the 1980s and 1990s because of its hallucinogenic effects.

Spravato nasal spray just received FDA-approval, and IV ketamine is already used in some U.S. clinics, to treat depression in people with persistent depression who are resistant to standard therapies. While the cost of IV treatments isn’t covered by medical insurance because it’s an off-label (unapproved) use of the drug, the new nasal spray probably will be covered.

In an interview with NPR, Dr. Dennis Charney, dean of the Icahn School of Medicine at Mount Sinai in New York, says about the drug, “This is potentially a game changer for millions of people. It offers a lot of hope.”

Although Spravato can produce psychotic episodes in some people, the effects are usually significantly milder than the effects of ketamine in its club-drug form, experts say.

The new medication does have a black box warning label (the FDA’s highest level) indicating an increased risk of:

  • Sedation
  • Impaired attention, judgment, and thinking
  • Abuse or misuse
  • Suicidal thoughts and behavior

You can only use Spravato under doctor supervision in a certified health care provider’s office or clinic. Due to the risk of sedation and other side effects, people taking it must be monitored by a medical professional for at least two hours after receiving the medication and make safe transportation arrangements afterwards. It can't be taken at home.

Common side effects are:

  • Anxiety
  • Decreased sensations or sensitivity
  • Dizziness
  • Feeling intoxicated
  • Increased blood pressure
  • Lethargy
  • Nausea and vomiting

According to the FDA, treatment-resistant depression is defined as persistent symptoms of major depressive disorder in people who’ve taken at least two antidepressants at adequate doses for an adequate duration in their current depressive episode.