Esketamine nasal spray is being developed as a treatment that could be given to people with depression with an imminent risk of suicide. Major depressive disorder (often called depression or major depression in UK) is a serious mood disorder that can impact all aspects of daily life. Symptoms can include low mood, weight changes, lack of energy, disturbed sleep, and suicidal intentions and thoughts. The time between suicidal thoughts and attempted suicide is often very short, and so there is a need for urgent intervention and treatment.
Esketamine is currently used as an anaesthetic given as an intravenous infusion but is being developed as a nasal spray in a lower dosage that has demonstrated rapid antidepressant effect with fewer side effects. Esketamine nasal spray has been shown to reduce suicidal thoughts within 2 hours of treatment, whilst standard antidepressants take 4-6 weeks to be fully effective. Esketamine nasal spray may offer an important and rapid treatment to bridge the gap between onset of acute symptoms of depression such as suicidal thoughts and the delay it takes for standard antidepressants to start working.
Brexanolone is an active product of the female reproductive hormone progesterone that regulates a specific neurotransmitter involved in a range of behaviours, including the stress
response. Some small studies have shown that brexanolone rapidly and significantly improves the symptoms of PPD and other hormonal mood disorders when compared to
other treatments. If licensed brexanolone would be the first PPD treatment that specifically targets the underlying disease process in PPD.