People’s Pharmacy: Spravato nasal spray for depression is out of reach

Q. I was a participant in a Phase 3 clinical trial for esketamine, which came to market as the nasal spray Spravato. The Food and Drug Administration approved it for treatment-resistant major depression, a condition I’ve suffered from for 15+ years.

The effect was profound: an immediate relief of all suicidal ideation and brain fog and great improvement in mood. When the study ended, I relapsed within a month.

My psychiatrist then prescribed generic ketamine, compounded as a nasal spray by a local pharmacy. It cost about $50 for a month’s supply. There was relief again, as well as no hallucinations or negative side effects.

Despite the positive effects, my doctor was uneasy about prescribing ketamine off-label and stopped. Spravato came on the market, but it’s prohibitively expensive – about $4,000-$6,000 a month for the dose/frequency I need. I am currently as depressed as I’ve ever been. It’s heartbreaking to know that the ketamine cure is out there, but I cannot access it.

A. Ketamine was developed as an injectable anesthetic agent and approved by the FDA in 1970 under the brand name Ketalar. It is still used as an anesthetic.

In 2002, Japanese researchers reported that small doses of ketamine “improved the postoperative depressive state and relieved postoperative pain in depressed patients” (Anesthesia and Analgesia, July 2002).

Since then, many other studies have shown that this old medication appears to have fast-acting antidepressant activity.

Esketamine (Spravato) is a chemical cousin of ketamine. It was approved for major depression in 2019. A meta-analysis confirms that this nasal spray does improve treatment-resistant major depression (Clinical Psychopharmacology and Neuroscience, May 31).

Spravato is very expensive. You might qualify for the Johnson & Johnson patient assistance program, though. If you are not eligible, your physician might continue to prescribe ketamine off-label if he better understood your circumstances.

Q. Despite being on medication for high blood pressure, mine remained high. My doctor recommended a blood pressure monitor. I was really surprised at how high the readings were.

My late mother suffered from high blood pressure and had three strokes before she died. Needless to say, I was really worried. The anxiety made my blood pressure even higher.

Recently, I started drinking beetroot juice each day. It has brought my evening blood pressure reading down considerably. Previously, that had been really high. I would certainly recommend beetroot juice.

A. Thank you for the excellent suggestion. There is a surprising amount of research on the benefits of beet juice to lower blood pressure. A new study in the British Journal of Clinical Pharmacology (February) found combining grapefruit juice with beetroot juice enhanced the blood-pressure lowering effect.

Beets are not the only vegetables to help control high blood pressure. Greens such as arugula, lettuce and spinach can also be helpful. To learn more about other nondrug approaches as well as pharmaceuticals, you may wish to read our eGuide to Blood Pressure Solutions in the Health eGuides section at peoplespharmacy.com.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website peoplespharmacy.com.