Depression makes everything harder — engaging with friends and family, going to work and even managing other health issues. Common symptoms include negative thinking, low energy, and changes in sleep and appetite. The illness is expensive too. A 2013 Gallup poll found that absenteeism and loss of productivity due to depression costs US businesses $23B annually. A separate analysis of the impact of depression on other medical costs showed that there is a 2-3 times increase compared with those without depression.
Antidepressants can help, but they can take anywhere from two to eight weeks to begin to take effect. And for some people, the drugs don’t work at all. Research shows that patients do best on a combination of antidepressants and counseling, but access to counseling services can be limited, and some people aren’t comfortable with that treatment approach.
The FDA recently approved two new antidepressants that promise a much more rapid effect. But neither drug can be administered easily, and both have raised concerns about their potential side effects and other risks.
Esketamine. A drug initially developed as a general anesthetic, esketamine has been approved as a nasal spray for individuals with major depression not responding to other medications. In clinical studies — all done on people who hadn’t responded to traditional antidepressants — some individuals experienced an almost immediate improvement of their symptoms. Potential side effects include high blood pressure, dizziness and hallucinations. The medication must be given in a physician's office where the patient can remain for two hours of observation, and the patient can’t drive home or for the next day. Treatment is twice a week for the first month and then weekly or every other week.
There are other concerns about esketamine. First, it is a drug of abuse so systems are needed to prevent it from being diverted. Second, there’s not much research on the long-term use of the medication for depression, and some early studies show that after a month of treatment, the drug isn’t any more effective than placebo.
Brexanalone. The second drug, brexanolone, has been approved for postpartum depression, which affects 400,000 women in the US annually. Like esketamine, brexanalone acts rapidly, allowing new moms to get back to taking care of their baby and themselves — traditional treatments can take from four to eight weeks to begin to have a positive effect. Brexanalone’s potential side effects include sudden loss of consciousness, so it can only be given under medical supervision in a hospital setting through what is known as a restricted distribution program at certified facilities. And it must be administered by infusion over 2 ½ hours.
These new treatments give patients and physicians more options to combat depression. And helping people feel better more quickly would have a profound effect on their lives and reduce the economic burden of depression on employers and society as a whole. Still, questions about the drugs’ safety and efficacy remain. Whether they can deliver on the promise of safe and quick treatment for depression remains to be seen.