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FDA Approves A Nasal Spray To Treat Patients Who Are Suicidal


The Food and Drug Administration has approved a fast-acting nasal spray for people who are at high risk of suicide. The spray contains a chemical cousin of the drug ketamine. Joining us live to tell us about this drug is NPR science correspondent Jon Hamilton.

Hi, Jon.


VANEK SMITH: So related to ketamine - is this a new drug?

HAMILTON: Well, not exactly. It's a drug called esketamine, which was approved last year as a treatment for major depression that hadn't responded to other treatments. And it's sold under the brand name Spravato. What the FDA has done now is add an approval for depressed patients who are at high risk of suicide. So they're having suicidal thoughts, or they've tried to commit suicide. And doctors told me that this could be a really important new option for getting patients through a crisis. I talked to Dr. Gerald (ph) Sanacora. He's a psychiatrist at Yale University. Here's what he told me.

GERARD SANACORA: There were remission rates over 40%. That remission means they're having minimal symptoms at the end of the month after coming into the emergency room with acute suicidal ideation.

VANEK SMITH: OK, Jon, so how is this drug different from other depression drugs?

HAMILTON: Well, the big difference is how fast it works. You know, most anti-depressants take weeks to have much of an effect. But esketamine works in hours, and that means it can bring some immediate relief to someone while they're waiting for other treatments to kick in. And the hope is that this can mean shorter hospital stays. Right now people admitted because they're suicidal may need to stay a week or more.

VANEK SMITH: So how exactly is this drug going to be used?

HAMILTON: Even though it is a nasal spray, it's definitely not something that's meant to be taken at home. Typically, someone who is considered at high risk for suicide will be brought to an emergency room or to a psychiatric facility. And that's where they're going to get this drug, which is really important because there can be side effects. You got blood pressure changes. You can have a sort of out of body experience that can last for an hour or so. And getting the drug is really just the first step. The idea is that they'll also get a range of other intensive treatments, including conventional anti-depressants and therapy. And even when they're discharged, they'll need to be monitored really closely and to see a mental health professional on a regular basis.

VANEK SMITH: Do we know whether this drug actually prevents suicide?

HAMILTON: Oddly, we don't. What we know is that it reduces suicidal thoughts and the symptoms of major depression. But the studies they've done so far really weren't meant to show whether people were less likely to have an attempted suicide in the months and years after they got treated. And Dr. Sanacora told me that's one of the reasons that patients really need to take a lot of care. They really need to get a lot of care in addition to this drug. Here's what he said.

SANACORA: What we have to be careful of is not to interpret that this is a medication you give once or twice and the person is fine, and you don't need the follow-up. Part of the reason that these studies showed such a big effect was that there was a very comprehensive follow-up plan built into this.

VANEK SMITH: Of course, Jon, we are in the middle of a pandemic right now that has been really hard on people with mental health challenges. Really quickly, it seems like this drug is coming at a very good time.

HAMILTON: It really does, and I spoke to a couple of doctors who said exactly that. I mean, there's some evidence that the pandemic has caused an increase in calls to suicide hotlines. It's definitely caused a lot of stress and anxiety. People have lost jobs. Some even lost family members. So there's a big need for new treatments to help people who are suicidal, and this is one of those.

VANEK SMITH: NPR's Jon Hamilton, thank you. And as a reminder to our listeners who might be struggling, the National Suicide Prevention Lifeline is 1-800-273-8255.

(SOUNDBITE OF JAY SOM SONG, "BAYBEE") Transcript provided by NPR, Copyright NPR.

Jon Hamilton is a correspondent for NPR's Science Desk. Currently he focuses on neuroscience and health risks.